Dataset Information

Meta-Analysis of Oxaliplatin-Based Chemotherapy Combined With Traditional Medicines for Colorectal Cancer: Contributions of Specific Plants to Tumor Response.

ABSTRACT: This meta-analysis evaluates the clinical evidence for the addition of traditional medicines (TMs) to oxaliplatin-based regimens for colorectal cancer (CRC) in terms of tumor response rate (TRR). Eight electronic databases were searched for randomized controlled trials of oxaliplatin-based chemotherapy combined with TMs compared to the same oxaliplatin-based regimen. Data on TRR from 42 randomized controlled trials were analyzed using Review Manager 5.1. Studies were conducted in China or Japan. Publication bias was not evident. The meta-analyses suggest that the combination of the TMs with oxaliplatin-based regimens increased TRR in the palliative treatment of CRC (risk ratio [RR] 1.31 [1.20-1.42], I(2) = 0%). Benefits were evident for both injection products (RR 1.36 [1.18-1.57], I(2) = 0%) and orally administered TMs (RR 1.27 [1.15-1.41], I(2) = 0%). Further sensitivity analysis of specific plant-based TMs found that Paeonia, Curcuma, and Sophora produced consistently higher contributions to the RR results. Compounds in each of these TMs have shown growth-inhibitory effects in CRC cell-line studies. Specific combinations of TMs appeared to produce higher contributions to TRR than the TMs individually. Notable among these was the combination of Hedyotis, Astragalus, and Scutellaria.

SUBMITTER: Chen M

PROVIDER: S-EPMC5736077 | biostudies-literature | 2016 Mar

REPOSITORIES: biostudies-literature

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Meta-Analysis of Oxaliplatin-Based Chemotherapy Combined With Traditional Medicines for Colorectal Cancer: Contributions of Specific Plants to Tumor Response.

Chen Menghua M May Brian H BH Zhou Iris W IW Xue Charlie C L CC Zhang Anthony L AL

Integrative cancer therapies 20150806 1

This meta-analysis evaluates the clinical evidence for the addition of traditional medicines (TMs) to oxaliplatin-based regimens for colorectal cancer (CRC) in terms of tumor response rate (TRR). Eight electronic databases were searched for randomized controlled trials of oxaliplatin-based chemotherapy combined with TMs compared to the same oxaliplatin-based regimen. Data on TRR from 42 randomized controlled trials were analyzed using Review Manager 5.1. Studies were conducted in China or Japan. ...[more]

PMID: 26254190

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Project description:Introduction: The incidence and mortality of gastric cancer ranks among the highest, and the 5-year survival rate of advanced gastric cancer (AGC) is less than 10%. Currently, chemotherapy is the main treatment for AGC, and oxaliplatin is an important part of the commonly used chemotherapy regimen for AGC. A large number of RCTs have shown that Chinese herbal medicine (CHM) combined with oxaliplatin-based chemotherapy can improve objective response rate (ORR) and disease control rate (DCR), reduce the toxic and side effects of chemotherapy. There is currently a lack of systematic evaluation of the evidence to account for the efficacy and safety of CHM combined with oxaliplatin-based chemotherapy in AGC. Therefore, we carried out this study and conducted the sensitivity analysis on the herbal composition to explore the potential anti-tumor efficacy. Methods: Databases of PubMed, EMBASE, CENTRAL, Web of Science, the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, the Wanfang database, and the Chinese Scientific Journals Database were searched from their inception to April 2022. RCTs evaluating the efficacy of CHM combined with oxaliplatin-based chemotherapy on AGC were included. Stata 16 was used for data synthesis, RoB 2 for quality evaluation of included RCTs, and GRADE for quality of synthesized evidence. Additional sensitivity analysis was performed to explore the potential anti-tumor effects of single herbs and combination of herbs. Results: Forty trials involving 3,029 participants were included. Most included RCTs were assessed as "Some concerns" of risk of bias. Meta-analyses showed that compare to oxaliplatin-based chemotherapy alone, that CHM combined with oxaliplatin-based chemotherapy could increase the objective response rate (ORR) by 35% [risk ratio (RR) = 1.35, 95% confidence intervals (CI) (1.25, 1.45)], and disease control rate (DCR) by 12% [RR = 1.12, 95% CI (1.08, 1.16)]. Subgroup analysis showed that compare to SOX, FOLFOX, and XELOX regimens alone, CHM plus SOX, CHM plus FOLFOX, and CHM plus XELOX could significantly increase the ORR and DCR. Sensitivity analysis identified seven herbs of Astragalus, Liquorice, Poria, Largehead Atractylodes, Chinese Angelica, Codonopsis, and Tangerine Peel with potentials to improve tumor response of oxaliplatin-based chemotherapy in AGC. Conclusion: Synthesized evidence showed moderate certainty that CHM plus oxaliplatin-based chemotherapy may promote improvement in tumor response in AGC. CHM treatment is safe for AGC. Due to the poor quality of included RCTs and small samplesizes, the quality of synthesized evidence was not high. Specific combinations of herbs appeared to produce higher contributions to ORR than the herb individually. Each of this seven above mentioned herbs has been shown in experimental studies to potentially contribute to the improvement of tumor response. To support this conclusion, these seven herbs are worthy of further clinical research. Systematic Review Registration: [http://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=262595], identifier [CRD42022262595].

Project description:ObjectiveTo access the comparative effectiveness and safety of different oral Chinese patent medicine (OCPM) versus oxaliplatin-based chemotherapy regimen (C) alone for colorectal cancer (CRC) through network meta-analysis (NMA).MethodsSeveral electronic databases were searched for randomized controlled trials (RCTs) concentrated on the use of OCPM to treat CRC with C from the inception of the databases to January 10, 2021. We performed frequentist NMA and indirect comparison to compare study outcomes from the included RCTs. The risk of bias of each study was assessed using the Cochrane risk of bias tool. Confidence in evidence was assessed using Confidence in Network Meta-Analysis (CINeMA).ResultsA total of 31 RCTs with 1985 participants comparing 10 OCPM, namely, Antike (ATK), Shenyi (SY), Huachansu (HCS), Boerning (BEN), Xiaoaiping (XAP), Jinlong (JL), Compound matrine (CC), Pingxiao (PX), Xihuang pill (XHW), Kangaiping (KAP) were identified. The methodological quality of included RCTs was not very high. The results of the NMA showed that the comparisons were all indirect. Among diverse OCPM, ATK + C had the highest objective response rate (ORR) with a P-score of .63 with risk ratio (RR) of 1.37 (95% CI 1.12-1.66); with a RR of 1.96 (1.26-3.05), SY + C had the highest performance status with a P-score of .73; KAP + C had the lowest nausea and vomiting with a P-score of .91 and with a RR of 0.29 (0.10-0.79); and JL + C had lowest leukopenia with a P-score of .95 with a RR of 0.47 (0.31-0.72). The results of pairwise comparison suggested no difference in outcomes among 10 kinds of OCPM + C. The comparison-adjusted funnel plots suggested that there might not be small-study effects for outcomes. According to the CINeMa approach, the confidence rating of this NMA ranged from "very low" to "low" for various comparisons.ConclusionBased on the NMA, ATK + C, SY + C, KAP + C and JL + C were associated with more preferable and options for CRC patients when referring to ORR, performance status, nausea and vomiting, and leukopenia, respectively. However, owing to the limitations of this research, the above conclusions require further verification by more high-quality RCTs.Prospero registrationCRD42020160658.

Project description:BackgroundThere are handful hypothesis-driven ethnobotanical studies in Nepal. In this study, we tested the non-random medicinal plant selection hypothesis using national- and community-level datasets through three different types of regression: linear model with raw data, linear model with log-transformed data and negative binomial model.MethodsFor each of these model, we identified over-utilized families as those with highest positive Studentized residuals and underutilized families with highest negative Studentized residuals. The national-level data were collected from online databases and available literature while the community-level data were collected from Baitadi and Darchula districts.ResultsBoth dataset showed larger variance (national dataset mean 6.51 < variance 156.31, community dataset mean 1.16 < variance 2.38). All three types of regression were important to determine the medicinal plant species selection and use differences among the total plant families, although negative binomial regression was most useful. The negative binomial showed a positive nonlinear relationship between total plant family size and number of medicinal species per family for the national dataset (β1 = 0.0160 ± 0.0009, Z1 = 16.59, p < 0.00001, AIC1 = 1181), and with similar slope and stronger performance for the community dataset (β2 = 0.1747 ± 0.0199, Z2 = 8.76, p < 0.00001, AIC2 = 270.78). Moraceae and Euphorbiaceae were found over-utilized while Rosaceae, Cyperaceae and Caryophyllaceae were recorded as underutilized.ConclusionsAs our datasets showed larger variance, negative binomial regression was found the most useful for testing non-random medicinal plant selection hypothesis. The predictions made by non-random selection of medicinal plants hypothesis holds true for community-level studies. The identification of over-utilized families is the first step toward sustainable conservation of plant resources and it provides a baseline for pharmacological research that might be leading to drug discovery.

Project description:ObjectivesThis network meta-analysis (NMA) was designed to assess the comparative effectiveness and safety of oral Chinese patent medicines combined with chemotherapy for gastric cancer on the National Basic Medical Insurance Drugs List of China.MethodsA comprehensive literature search was performed in seven electronic databases from their inception to February 25, 2020, aiming to collect all related randomized controlled trials (RCTs) to evaluate the effectiveness and safety of oral Chinese patent medicines as an adjuvant for gastric cancer. Two researchers independently screened the literature, extracted data, and assessed the risk of bias of included studies using the Cochrane Risk of Bias Scale. NMA was then performed by using STATA 16.0 software and ADDIS 1.16.8 software.ResultsFinally, 30 RCTs were included, involving seven kinds of oral Chinese patent medicines, with a total of 2602 patients. For improvement of clinical efficacy, Bazhen granule combined with chemotherapy was ranked first for effectiveness, followed by the Cinobufacin capsule combined with chemotherapy and Xiao'aiping tablet combined with chemotherapy. Meanwhile, Bazhen granules combined with chemotherapy also were ranked first in reducing gastrointestinal reactions. In terms of improving performance status, the Xiao'aiping tablet was the best and significantly better than other oral Chinese patent medicines. Besides, the Zhenqi Fuzheng granule combined with chemotherapy was best for reducing the incidence of leucopenia.ConclusionsSince only one RCT of Bazhen granule was included in this study for analysis, its statistical efficiency is low. Therefore, this study recommends that the Cinobufacin capsule combined with chemotherapy should be a priority in improving clinical efficacy. In terms of improving patients' quality of life, Xiao'aiping tablet is the best choice. Safety was best for Zhenqi Fuzheng granule and Bazhen granule combined with chemotherapy. Limited by the quantity, quality, and possible bias of included studies, the above conclusions need to be further verified by more high-quality RCTs.

Dataset Information

Meta-Analysis of Oxaliplatin-Based Chemotherapy Combined With Traditional Medicines for Colorectal Cancer: Contributions of Specific Plants to Tumor Response.

Publications

Meta-Analysis of Oxaliplatin-Based Chemotherapy Combined With Traditional Medicines for Colorectal Cancer: Contributions of Specific Plants to Tumor Response.

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