Views:29 Author:Natalia Publish Time: 2015-11-30 Origin:Evidence-Based Complementary and Alternative Medicine
Chinese Herbal Medicines as an Adjunctive Therapy for Unresectable Pancreatic Cancer: A Systematic Review and Meta-Analysis
TCM has increasingly drawn a wider range of interest as a complementary and alternative therapy among international cancer research studies because it can increase efficacy and decrease toxicity when combined with radiotherapy and chemotherapy. Furthermore, the integration of palliative care in cancer patients has become standard oncology practice when a patient is diagnosed with metastatic or advanced cancer according to NCCN clinical practice guidelines. In China, TCM has a longstanding history and is deeply embedded in rural and urban populations as a measure of palliative care. To our excitement, TCM has also been accepted into Chinese clinical practice guidelines in the treatment of pancreatic cancer. Recent reported studies have demonstrated that 90% of Chinese patients with cancer have received diverse TCM treatments during their treatment regimen. Preclinical studies have demonstrated that CHM can suppress tumor proliferation and metastasis. For example, the famous Qingyi Huaji formula, which was found and established from the cancer center of Fudan University in China, can inhibit the growth of liver metastasis from pancreatic cancer in nude mice, inhibit the cell cycle in pancreatic cancer CFPAC-1 cells and inhibit pancreatic cancer cell invasion and metastasis in part by reversing tumor-supporting inflammation. Though CHM has multiple complicated components and probable adverse effects, its application has been widely embraced in clinical practice, especially throughout China. This phenomenon is attributed to the fact that the origin and development of TCM are intricately entwined with Chinese history, culture, economy, and politics and that its compelling efficacy has been attested. The present study has revealed that CHM can increase the role of antitumor therapies and improve quality of life in pancreatic cancer patients, which will provide more evidence to promote the application of CHM in China as well as to gain worldwide approval and benefit for pancreatic cancer patients.
The increase in overall survival remains the still focus of treatment of cancer patients, and the efficacy of antitumor treatment is typically evaluated by observing effects on survival. Prior to our meta-analysis, a meta-analysis was published in Chinese, but there was no evaluation associated with survival time, quality of life and adverse effects. In this study, more than fivefold the number of studies were included in the pooled analysis. The 6-month survival rate and 1-year survival rate of CHM-containing regimens are clearly increased compared with non-CHM-containing schemes in patients with advanced pancreatic cancer by using random-effects and fixed-effects model respectively, which suggests that CHM contributes to prolonged survival. The above data suggest that CHM likely exhibits antitumor role and synergetic effects in combination with other therapies that have been approved worldwide, including in the USA. PHY906 from the traditional Chinese herbal formulation Huang-Qin-Tang has been involved in a series of preclinical studies and clinical research in USA. The treatment appears to be a safe and feasible salvage therapy with treatment with capecitabine plus PHY906 in advanced pancreatic cancer. Improvement of quality of life in this meta-analysis has been reported in studies associated with cancer, and the research on PHY906 indicates improvements compared with baseline levels.
TCM is based on a completely different theoretical system than Western medicine in which the name of disease is formed by using symptoms of the disease. Pancreatic cancer is attributed to the JiJu and FuLiang symptoms in TCM and has a pathological process that includes deficiency of healthy Qi and excess of evil pathogenic Qi. Therefore, reinforcing the healthy Qi and eliminating excess evil pathogenic Qi, including phlegm, dampness, heat, and stasis toxin, represent the main treatment principles of pancreatic cancer. This study indicated clearly that the application of CHM complied entirely with these principles according to the analysis of CHM frequency. Moreover, certain new reports have indicated that the composition of CHMs includes compounds that regulate immunity function and have antitumor potency in vitro and in vivo, such as ginsenoside, Astragalus polysaccharides, Atractylenolide, an ethanol extract of Hedyotis diffusa, and Bufalin.
Meanwhile, in this study, some herbal medicines, which were applied extensively in patients with malignant tumor, were verified to have beneficial role. For example, Baihuasheshecao, an old and well-known traditional Chinese medicine, is composed of abundant chemical ingredients and has antitumor activity.
In conclusion, the pooled data present compelling evidence that CHM is a promising strategy as an adjunctive therapy in treating unresectable and advanced pancreatic cancer and that TCM in combination with conventional therapy is useful for overcoming this stubborn disease. However, high-quality and precisely evaluated research as well as improvements in the quality of the reported trials, particularly in the descriptions of methodology and study processes, is urgently needed.
Pancreatic cancer is a common malignancy with a high mortality. Most patients present clinically with advanced pancreatic cancer. Moreover, the effect of radiotherapy or chemotherapy is limited. Complementary and alternative medicines represent exciting adjunctive therapies. In this study, we ascertained the beneficial and adverse effects of Chinese herbal medicine (CHM) in combination with conventional therapy for inoperable pancreatic cancer by using meta-analysis methods for controlled clinical trials. We extracted data for studies searched from six electronic databases that were searched and also assessed the methodological quality of the included studies. We evaluated the following outcome measures: 6-month and 1-year survival rate, objective response rate, disease control rate, quality of life, and adverse effects. The final analysis showed CHM is a promising strategy as an adjunctive therapy to treat advanced or inoperable pancreatic cancer and that CHM in combination with conventional therapy is a promising strategy for resistant disease. However, convincing evidence must be obtained and confirmed by high-quality trials in future studies.
Read the whole study here.
Bin Li, Run Gan, Quanjun Yang, et al., “Chinese Herbal Medicines as an Adjunctive Therapy for Unresectable Pancreatic Cancer: A Systematic Review and Meta-Analysis,” Evidence-Based Complementary and Alternative Medicine, vol. 2015, Article ID 350730, 15 pages, 2015. doi:10.1155/2015/350730