Abstract
Introduction: Aidi injection (Aidi) is composed of cantharidin, astragaloside, ginsenoside, and elentheroside E. As an important adjuvant therapy, Aidi in combination with gemcitabine and cisplatin (GP) is often used in the treatment of non-small cell lung cancer (NSCLC). Objectives: We performed a new evaluation to demonstrate the clinical efficacy and safety of the Aidi and GP combination and further explored an optimal strategy for achieving an ideal response and safety level in advanced NSCLC. Methodology: We collected all the related trials from Chinese and English-language databases, analyzed their methodological bias risk using the Cochrane evaluation Handbook for Systematic Reviews of Interventions Version 5.1.0, extracted all the data using a predefined data extraction form, pooled the data using a series of meta-analyses, and finally summarized the quality of evidence using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. Results: We included 70 trials with 5,509 patients. Compared with GP alone, the Aidi and GP combination showed a significant improvement in the objective response rate (ORR) [1.82 (1.62–2.04)], disease control rate (DCR) [2.29 (1.97–2.67)], and quality of life (QOL) [3.03 (2.55–3.60)] and a low incidence of hematotoxicity and gastrointestinal and hepatorenal toxicity. Aidi might be more suitable for patients who are first-treated, elderly, or patients with a Karnofsky Performance Status (KPS) score ≥ 60 or anticipated survival time (AST) ≥3 months. An Aidi (50 ml/day, 7–14 days/cycle for one to two cycles), gemcitabine (1000 mg/m2), and cisplatin (20–30 mg/m2, 40–50 mg/m2, or 60–80 mg/m2) might be an optimal regimen for realizing an ideal response and safety level. Most results were robust and of moderate quality. Conclusion: Current evidence indicates that Aidi's value in adjuvant chemotherapy may be broad-spectrum, not just for some regimens. The Aidi and GP combination may show a good short-term response, antitumor immunity, and safety level in patients with NSCLC. Aidi (50 ml/day, 7–14 days/cycle for one and two cycles) with GEM (1000 mg/m2) and DDP (20–30 mg/m2 or 40–50 mg/m2) may be an optimal regimen for realizing an ideal goal in patients who are first-treatment, elderly, or have a KPS score ≥ 60 or AST≥3 months.
Highlights
Aidi injection (Aidi) is composed of cantharidin, astragaloside, ginsenoside, and elentheroside E
Basic Features of the Included Trials. In this meta-analysis, we identified 70 trials from China, which involved 5,509 non-small cell lung cancer (NSCLC) patients including 3,278 males and 1,995 females with ages ranging from 21–86 years old (Table 1)
The results showed that no publication bias was found for Objective response rate (ORR), quality of life (QOL), myelosuppression, thrombocytopenia, anemia, gastrointestinal toxicity, liver toxicity, renal toxicity, or CD4+/CD8+ T cell ratios
Summary
Aidi injection (Aidi) is composed of cantharidin, astragaloside, ginsenoside, and elentheroside E. The active ingredients comprise the following main components: astragaloside (Re, Rb1, and Rg1), ginsenoside, cantharidin, elentheroside E, and syringin (Zhang et al, 2012; Zeng et al, 2016) These are purported to induce tumor cell apoptosis and to inhibit tumor cell proliferation and invasion (Duan et al, 2018b; Chen et al, 2019; Li et al, 2019), to reduce chemotherapy-related ADRs through anti-inflammation and antioxidative stress (Farag et al, 2019; Qu et al, 2019; Zhang et al, 2019), and to repair the host’s antitumor immunity though upregulating the levels of peripheral blood lymphocytes (PBLs) (Li et al, 2018; Zhou et al, 2018; Huang et al, 2019). All these questions have become new obstacles to developing an optimal treatment strategy against advanced NSCLC and need to be confirmed by new evaluation
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