Abstract
Title. Chemotherapy-induced myelosuppression lowers the quality of life in breast cancer patients and causes many complications. Traditional Chinese Medicine (TCM) is a widely used complementary and alternative medicine therapies. Objective. To study whether TCM can reduce the incidence of chemotherapy-induced leukopenia, neutropenia, and febrile neutropenia (FN) in breast cancer patients. Methods. The data were analyzed retrospectively between patients who received TCM treatment (group 1, n = 453) and patients who did not receive TCM treatment (group 2, n = 359). Significant risk factors associated with the occurrence of chemotherapy-induced leukopenia, neutropenia, and FN were identified using multivariate analysis. Propensity score-matched patients were analyzed to adjust for any baseline differences. Results. Group 1 patients had a significantly lower rate of chemotherapy-induced severe leukopenia, neutropenia, and FN, compared with group 2 (43% versus 71%, P < 0.0001, 72% versus 78%, P = 0.005, 6% versus 24%, P < 0.0001, resp.). Multivariate analysis revealed that chemotherapy regimens containing anthracyclines combined with paclitaxel or docetaxel were the most significant predictor. Subgroup analysis indicated that TCM treatment showed benefit in relieving chemotherapy-induced leukopenia and FN in most chemotherapy regimens. Conclusions. TCM treatment could lower the risk of severe chemotherapy-induced leukopenia, neutropenia, and FN in breast cancer patients.
Highlights
Chemotherapy is one of the major categories of pharmacotherapy for breast cancer
Previous studies had shown that some Traditional Chinese Medicine (TCM) could reduce the side effects of chemotherapy, modulate immune effector cells, and relieve chemotherapy-induced myelosuppression [13,14,15,16]
Researchers explained the effectiveness of some herbs on neutrophils by biochemical tests and attributed these to [17,18,19,20] (i) improving the bone marrow hematopoietic microenvironment; (ii) improving the cyclin D1 expression, promoting cell cycles in the G0/G1 phase to enter the S, G2/M phases to accelerate hematopoietic progenitor cell proliferation and differentiation, and involving the PI3K/AKT pathway to thereby prevent bone marrow nucleated cells from apoptosis; and (iii) regulating the immune function and the expression of CDK4 and CDK6 in bone marrow and tumor tissues, stimulating the expression of IL-1β, IL-3, IL-6, SCF, and GM-CSF and inhibiting the expression of TGF-β
Summary
Chemotherapy-induced leukopenia, neutropenia, and FN are the most common and doselimiting toxicity of cytotoxic anticancer agents and often increase the susceptibility to the development of infections in breast cancer patients [1, 2]. Severe leukopenia, neutropenia, and FN often result in treatment delay or dose reduction and discontinuation, which may compromise the long-term clinical outcome and lower the disease-free and overall survival rates [3,4,5]. TCM has a long history of application to disease treatment in China and has been used in numerous patients [6]. Previous studies have demonstrated that Oldenlandia diffusa or Scutellaria barbata have antiproliferative effects on breast cancer cells in vitro and promising clinical effects in patients [8, 9]. There is no report regarding the benefit of TCM in alleviating
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