Abstract
BackgroundMarsdenia tenacissima extract (MTE) is a phytochemical widely used as complementary therapy in cancer care. This systematic review was conducted to investigate the anticancer and detoxification effects of MTE, as an adjuvant therapy to chemotherapy, for treating gastric cancer.MethodsTen databases were searched to identify randomized controlled trials (RCTs) comparing oral or injectable MTE plus chemotherapy versus chemotherapy alone for treating gastric cancer up to May 1, 2019. In meta-analyses, proportional odds ratios (PORs) with 95% confidence intervals (CIs) were pooled for the ordinal outcomes using the generalized linear model, and risk ratios (RRs) with 95% CIs were pooled for dichotomous outcomes using the Mantel-Haenszel method.ResultsSeventeen RCTs with 1329 individuals were included, with a moderate to high risk of selection and performance bias. Compared to chemotherapy alone, MTE adjuvant therapy significantly improved the response to anticancer treatment (POR 2.01, 95% CI 1.60–2.53) and patients’ performance status (POR 3.15, 95% CI 2.22–4.48) and reduce the incidences of chemotherapy-induced leukopenia (RR 0.66, 95% CI 0.56–0.78), thrombocytopenia (RR 0.64, 95% CI 0.48–0.86), anemia (RR 0.89, 95% CI 0.72–1.10), nausea/vomiting (RR 0.79, 95% CI 0.69–0.91), hepatic injury (RR 0.77, 95% CI 0.61–0.96), and peripheral neurotoxicity (RR 0.77, 95% CI 0.59–1.01). However, MTE did not significantly alleviate anemia, diarrhea, constipation, kidney injury, and oral mucosal lesions after chemotherapy. Incidence of nausea/vomiting was lower in patients receiving oral MTE than those receiving injectable MTE (RR 0.47 vs. 0.82, interaction P = 0.04). Heterogeneity was generally low among these outcomes. Three out of five RCTs that reported survival data supported the effects of MTE for prolonging progression-free and/or overall survival. No studies reported safety outcomes of MTE.ConclusionsThe current evidence with limitations of risk of selection and performance bias suggests that MTE, as an adjuvant therapy to chemotherapy, is effective for inhibiting cancer growth and reducing incidences of multiple chemotherapy side effects. Oral MTE may be a better choice. Uncertainty remains regarding the effects of MTE on survival endpoints and the subgroup differences between acute and chronic use of MTE and between different chemotherapy regimens.
Highlights
Marsdenia tenacissima extract (MTE) is a phytochemical widely used as complementary therapy in cancer care
We reported this systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (Additional file 1) [13]
Risk of bias assessment We evaluated the following domains of bias for each randomized controlled trials (RCTs) referring to the Cochrane risk of bias tool [17]: 1) selection bias; 2) performance bias; 3) detection bias; 4) attrition bias; 5) reporting bias; and 6) other bias
Summary
Marsdenia tenacissima extract (MTE) is a phytochemical widely used as complementary therapy in cancer care. This systematic review was conducted to investigate the anticancer and detoxification effects of MTE, as an adjuvant therapy to chemotherapy, for treating gastric cancer. Chemotherapy can be used for both patients with early and advanced gastric cancer [3]. Patients who received chemotherapy probably experience toxic side effects, such as gastrointestinal reactions, myelosuppression, and hepatic injury, which substantially reduce patients’ quality of life and even cause life-threaten complications (e.g. acute infections) [6]. Clinicians, hope to find complementary and alternative approaches for improving the anticancer efficacy and reducing the chemotherapy side effects in the treatment of gastric cancer. Phytochemicals derived from herbal medicine have been developed and used for a complementary and alternative therapy in cancer care worldwide [7]. Multiple phytochemicals have been proven to be effective for anticancer, such as alkaloid, benzopyran, and coumarin [8]
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