Abstract
Aim: We conducted a systematic review of high-quality randomized controlled trials (RCTs) to assess the efficacy and safety of Chinese herbal medicine (CHM) for the treatment of chemotherapy-induced leukopenia (CIL). Methods: Eight electronic databases were searched from the date of inception to November 4, 2020 for high-quality RCTs that met the requirements of at least four key domains of the Cochrane risk of bias (RoB) tool. RevMan 5.3 was applied for the meta-analysis. Results: Fourteen RCTs involving 1,053 patients were included. The pooled results showed that CHM + chemotherapy exerted greater beneficial effects on white blood cell (WBC), neutrophil (NEU), hemoglobin (Hb), and platelet (PLT) counts in addition to the Karnofsky performance scale (KPS) score, but showed no significant difference on granulocyte colony-stimulating factor (G-CSF) dosage compared with chemotherapy alone. Placebo (PBO) + chemotherapy and CHM + chemotherapy groups showed no significant differences in terms of reduction of the incidence of neutropenia. CHM + chemotherapy was superior to Western medicine (WM) + chemotherapy in improving the WBC count, KPS, infection amount, G-CSF use rate, and incidence of leukopenia. In addition, no severe adverse events were observed in the 14 RCTs. Conclusion: CHM in combination with chemotherapy could effectively improve the clinical symptoms of CIL when compared with chemotherapy alone or Western medicine + chemotherapy, except when comparing with PBO + chemotherapy. While CHMs were generally safe for clinical use and exerted no severe side effects in the 14 RCTs, high-quality RCTs with larger sample sizes are essential to reduce study heterogeneity.
Highlights
Chemotherapy is widely applied for treatment of multiple cancer types, with one or more anticancer drugs generally used as part of a standardized chemotherapy regimen in the clinic (Johnstone et al, 2002)
Chemotherapy drugs often have poor targeting problems, and combined application of several drugs inevitably results in a series of adverse events (Sarah, 2013), such as bone marrow dysfunction, peripheral neuropathy, chronic pain, sleep disorders, nausea and vomiting, fatigue, and flushes, which negatively affect curative effects and lead to severe patients’ discomfort and poor quality of life (QOL) posttreatment (Torre et al, 2015; Kato et al, 2019; Makary et al, 2019)
Long-term usage of cytotoxic drugs is clearly associated with chemotherapy-induced leukopenia (CIL) (Merryman et al, 2012)
Summary
Chemotherapy is widely applied for treatment of multiple cancer types, with one or more anticancer drugs generally used as part of a standardized chemotherapy regimen in the clinic (Johnstone et al, 2002). Long-term usage of cytotoxic drugs is clearly associated with chemotherapy-induced leukopenia (CIL) (Merryman et al., 2012). To increase the white blood cell (WBC) counts within a short time frame for the maintenance of therapeutic efficacy and continue subsequent courses of treatment, granulocyte colony-stimulating factor (G-CSF) is commonly used to treat CIL (Winkler et al, 2016). For patients with severe myelosuppression, repeated treatment is required to maintain the curative effects of chemotherapy. Treatments that can facilitate effective and stable relief of CIL and promote patients’ QOL by consolidating the clinical value of previous chemotherapeutic regimens and ensuring continuation of therapy are currently a hot topic of research
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