Optimal Chinese herbal injections plus paclitaxel-based chemotherapy for advanced non-small cell lung cancer: A systematic review and Bayesian network meta-analysis

Abstract

BackgroundConsidering the extensive exploration of Chinese herbal injections (CHIs) and the limitations of paclitaxel-based chemotherapy (TBC) for non-small cell lung cancer (NSCLC), systematically and critically evaluating the efficacy and safety of CHIs combination with TBC in the treatment of NSCLC is necessary. PurposeTo investigate the combined efficacy and safety of CHIs plus TBC on patients with advanced NSCLC. MethodsThe databases PubMed, Embase, Medline, Cochrane Library, CINAHL, China Biology Medicine disc, Wanfang, VIP, and China National Knowledge Infrastructure were systematically searched from their inception to Oct. 15, 2020. We selected randomized controlled trials (RCTs) regarding CHIs plus TBC to treat NSCLC. The methodological quality of included studies was evaluated based on the Cochrane risk-of-bias tool. Data synthesis was performed by WinBUGS 14.0 software and meta packages implemented in R 3.6.2 software. Random-effects network meta-analysis was performed and dichotomous data were expressed as odds ratios (ORs) with their 95% confidence intervals. The surface under the cumulative ranking curve probability values was used to rank the efficacy and safety of CHIs. The objective response rate (ORR) and disease control rate (DCR) was defined as the primary outcomes, and the secondary endpoints were quality of life (QOL) and adverse drug reactions (ADRs). ResultsNinety-three RCTs recruiting 6626 advanced NSCLC patients were included and 7 types of CHIs were evaluated. Compared to TBC alone, CHIs plus TBC can significantly improve ORR, DCR, and QOL; and reduce the risk of neutropenia, thrombocytopenia, anemia, nausea and vomit, and liver injury. Multidimensional cluster analysis results demonstrated that Huachansu injection (HCS) plus TBC and Xiaoaiping injection (XAP) plus TBC were preferable improvements on ORR, DCR, and QOL, as well as a decrease in the risk of ADRs, compare with other types of CHIs. ConclusionsCurrent moderate evidence revealed that CHIs plus TBC showed significantly higher efficacy and lower risk of ADRs for advance NSCLC patients than TBC alone. Thereinto, HCS plus TBC and XAP plus TBC were related to higher rank probabilities considering the efficacy and safety. High-quality RCTs with longer follow-ups are urgently needed to confirm the results further.