Chinese medical herbs for chemotherapy side effects in colorectal cancer patients

 

Abstract

Background

Side effects, including nausea and vomiting, sore mouth , diarrhoea, hepatotoxicity, myelosuppression, and immunosuppression , are commonly encountered in patients with colorectal cancer who are treated with chemotherapy. A variety of Chinese herbal medicines have been used for managing these adverse effects.

Objectives

To assess the effect of herbal medicines plus chemotherapy, compared with chemotherapy alone, on the side effects of chemotherapy on the quality of life, and on adverse events in patients with colorectal cancer.

Search methods

We searched the Cochrane Library, MEDLINE, EMBASE, CBM, and handsearched the relevant Chinese journals.

Selection criteria

Randomised trials comparing either chemotherapy only or chemotherapy plus anti-emetics (tropisetron, sulpiride etc) with chemotherapy plus Chinese herbs.

Data collection and analysis

Trial quality was assessed independently by two reviewers. Data were extracted by one reviewer and checked by the second reviewer. Since the four included studies differed significantly in design, we could only perform limited meta-analyses. We have therefore presented the majority of the data in narrative form.

Main results

We included four relevant trials. All of them were of low quality. All of studies used a decoction containing Huangqi compounds as the intervention with chemotherapy. The intervention groups of three studies were compared to a chemotherapy alone control group, the fourth study compared the decoction of Huangqi compounds with two other Chinese herbal interventions. None of the studies reported on primary outcome using Common Toxicity Criteria (CTC). There was a significant reduction in the proportion of patients who experienced nausea & vomiting when decoctions of Huangqi compounds were given in addition to chemotherapy. There was also a decrease in the rate of leucopenia (WBC <3 x 10^9 per L). Huangqi compounds were also associated with increases in the proportions of T-lymphocyte subsets: CD3; CD4 and CD8. Huangqi decoctions had no significant effects on Immunoglobulins G, A or M.

Authors' conclusions

Despite the included studies being of low quality, the results suggest that decoctions of Huangqi compounds may stimulate immunocompetent cells and decrease side effects in patients treated with chemotherapy. Due to the methodological limitations of the studies, there is no robust demonstration of benefit. We found no evidence of harm arising from the use of Chinese herbs. We need high quality randomised controlled studies investigating the effects of decoctions of Chinese herbs, particularly Astragalus spp.(as in Huangqi), upon chemotherapy-related side effects.

 

Plain language summary

Chinese medical herbs for chemotherapy side effects in colorectal cancer patients

Chinese herbal medicines are widely used to counteract the side-effects of chemotherapy in patients being treated for cancer. As yet, there is no clear evidence that herbal medicines are effective in this role. We have performed a systematic review of the potential benefits of Chinese herbal medicines in patients being treated with chemotherapy for colorectal cancer. We identified four relevant studies, which included a total of 342 patients, with adequately reported data. We conclude that, from the limited information available, there is some evidence of benefit from decoctions of Huangqi compounds. Compared with patients treated by chemotherapy alone, patients treated with chemotherapy and Huangqi decoctions were less likely to experience nausea and vomiting or low white cell counts. There was some evidence to suggest that the decoctions also stimulated cells of the immune system, but did not affect the levels of antibodies in the blood. We could find no evidence of harm arising from the use of Huangqi decoctions. Our results suggest that further, larger-scale, trials of the use of Huangqi decoctions in the prevention of chemotherapy-related side-effects are needed.

 

摘要

背景

中草藥對於大腸癌患者化療副作用的影響

通常大腸癌患者使用化學治療的副作用，包括噁心，嘔吐，口腔疼痛，腹瀉，肝毒性，骨髓抑制和免疫抑制.各式各樣的中藥已經被用來處理這樣的不良影響.

目標

為了評估大腸癌患者草藥加化療比單純化療的效果,化療副作用,生活品質，不良事件

搜尋策略

我們搜尋了Cochrane Library, MEDLINE, EMBASE, CBM, and handsearched the relevant Chinese journals

選擇標準

隨機試驗比較單純化療或化療+止吐藥(tropisetron, sulpiride 等)與化療加中藥.

資料收集與分析

二個評論者獨立地估計試驗質量.數據由一個評論者提取並且由第二個評論者檢查. 由納入研究的四個顯著不同的設計，我們只能進行有限的分析。因此，我們提出的多數數據用敘述形式。

主要結論

我們包括四次相關的試驗.所有這些都是低質量的.所有研究使用含有黃岐湯化合物介入化療.干預小組三項研究和化療單獨控制組比較.第四個研究比較了黃耆湯化合物與其他兩個中藥干預措施.使用CTC沒有研究報告顯示主要結果.給予化療加黃耆煎劑化合物,患者噁心和嘔吐比例顯著減少。白血球減少症的發生率也下降(WBC < 3 × 109 per L).黃耆化合物也與增加T淋巴細胞亞群:CD3，CD4和CD8的比例有關。黃耆煎劑對免疫球蛋白G，A或M無明顯影響.

作者結論

儘管包括的研究是低質量,結果仍然表示表，對於化療治療的患者,黃耆煎劑化合物可以刺激免疫活性細胞，減少副作用.由於研究的方法學局限,並沒有強大的示範效益.我們並沒有發現使用中藥會有任何危害的證據,我們需要高質量的隨機對照研究，調查中藥湯劑的影響與化療相關的副作用，特別是黃耆屬(如黃耆).

翻譯人

本摘要由國泰綜合醫院張世昌翻譯。

此翻譯計畫由臺灣國家衛生研究院(National Health Research Institutes, Taiwan)統籌。

總結

中藥材廣泛用於抵消正在接受化療治療的癌症患者的副作用.到今天為止,沒有明確的證據表明，草藥能有效發揮作用.我們已經進行了系統審查,對於正在接受化學治療的大腸癌患者,使用中藥材的潛在利益.我們確定了四項有關的研究,其中包括數據與報告充分的342例,從有限的資料,我們的結論是有一些證據顯示黃耆化合物的好處.和單純化療的患者比較,使用化療和黃耆煎劑的患者較少出現噁心嘔吐或低白血球細胞症,有一些證據表明，中藥方劑也刺激細胞的免疫系統，但是不影響抗體在血液中的水平.使用黃耆湯,我們找不到任何產生危害的證據.我們的結果建議,更進一步大規模的試驗使用黃耆煎劑預防化療相關的副作用是必要的。