The Therapeutic Principle of Combined Strengthening Qi and Eliminating Pathogens in Treating Middle-Advanced Primary Liver Cancer: A Systematic Review and Meta-Analysis

Abstract

Background: The combination of strengthening Qi and eliminating pathogens is an available therapeutic principle in traditional Chinese medicine (TCM) for primary liver cancer (PLC) at middle-advanced stage. However, there is a lack of reasonable evidence to support the proper application of this therapeutic principle. This meta-analysis aims to evaluate the efficacy and safety of Chinese medicinal formulas (CMFs), including two subgroup analyses of the principle of strengthening Qi and eliminating pathogens.Method: Clinical trials were obtained through searching of EMBASE, Web of Science, PubMed, Cochrane Library, Chinese National Knowledge Infrastructure, Wanfang Database, Chinese Scientific Journal Database, Chinese Biomedical Literature Database, and two clinical trial registries. The randomized controlled trials with the combination of CMFs and transcatheter arterial chemoembolization (TACE) in the experiment group were acceptable, in contrast to the TACE alone in the control group. The statistics analysis was performed on Review Manager 5.4.Results: A total of eligible 24 trials were accessed in this work. Overall, CMFs could improve the survival duration of 6 months, 1 year, and 2 years, Karnofsky Performance Status, tumor objective response rate (ORR), AFP, and symptom. In the subgroup analysis, trials complying with the principle of single strengthening Qi did not show any significant difference in increasing tumor ORR. Meanwhile, the principle of combined strengthening Qi and eliminating pathogens was uncertain in improving symptoms and 1-year and 2-year survival time. In addition, the outcome indexes of ALT and AST were heterogeneous. In last, the total occurrence of adverse events could not be reduced via using CMFs. Patients treated with CMFs exhibited liver injury, fever, and white blood cell decline, with mild events occurring more frequently and severe events occurring less.Conclusion: CMFs are an effective treatment method to cure PLC at the middle-advanced stage. Adopting the principle of single strengthening Qi presents better efficacy in the long term by prolonging the survival duration. Following the principle of combined strengthening Qi and eliminating pathogens could be more beneficial to patients in short term by lessening the tumor size. CMFs have the advantage of reducing certain serious adverse events.

The Effects of Complementary Therapies on Patient-Reported Outcomes: An Overview of Recent Systematic Reviews in Oncology

“…The effect of herbal medicine on gastrointestinal symptoms is often meta-analyzed (see Table 5 ). The included meta-analyses showed significant negative effects of herbal medicine on the incidence of nausea and vomiting and diarrhea [ 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ]. Inappetence was significantly relieved in patients with primary liver cancer using Chinese medicinal formulas [ 57 ].…”

“…The included meta-analyses showed significant negative effects of herbal medicine on the incidence of nausea and vomiting and diarrhea [ 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 ]. Inappetence was significantly relieved in patients with primary liver cancer using Chinese medicinal formulas [ 57 ]. In patients with colorectal cancer, anorexia , constipation and abdominal pain were not found to be significantly alleviated by the use of traditional herbal medicines, but abdominal distension was [ 55 ].…”

Clinical Efficacy and Safety of Traditional Medicine Preparations Combined With Chemotherapy for Advanced Pancreatic Cancer: A Systematic Review and Meta-Analysis

“…to achieve maximal efficacy in cancer therapy with minimal adverse reactions ( 57 ). Numerous studies have described the clinical efficacy and safety of TMPs for colorectal cancer ( 58 ), non-small cell lung cancer ( 59 ), and liver cancer ( 60 ), as well as for some cancer-related symptoms such as insomnia ( 61 ), pain ( 62 ), and anemia ( 63 ). Thus, mining TMPs with scientific and systematic methods can serve as an important strategy for cancer treatment.…”

Metabolomics and integrated network pharmacology analysis reveal SNKAF decoction suppresses cell proliferation and induced cell apoptisis in hepatocellular carcinoma via PI3K/Akt/P53/FoxO signaling axis

“…Specifically, Traditional Chinese Medicine (TCM) has been extensively adopted as a pool filed with numerous new therapeutic agents due to its beneficial effects, accessible availability, and restricted adverse effects. Notably, it has found that Chinese medicinal formulas (CMFs) could be beneficial to HCC patients with approximately 1–2-years survival time [ 12 , 13 ].…”