Oral Chinese herbal medicine (CHM) as an adjuvant treatment during chemotherapy for non-small cell lung cancer: A systematic review

Abstract

Background

Non-small cell lung cancer (NSCLC) remains a major global health problem because of its prevalence and poor prognosis. Treatment options are limited and there is a need to explore alternatives. This systematic review evaluates the role of Chinese herbal medicine (CHM) in association with chemotherapy for NSCLC.

Methods

English and Chinese databases were searched for RCTs comparing CHM with conventional biomedical treatment or placebo. Papers were reviewed systematically and data were analysed using standard Cochrane software Revman 5.

Results

Fifteen Chinese trials involving 862 participants met the inclusion criteria. All trials were of poor quality with a considerable risk of bias. There was a significant improvement in quality of life (QoL) (increased Karnofsky Performance Status) (RR 1.83, 95% CI 1.41–2.38, p < 0.00001 for both stages III, IV only NSCLC and all stages NSCLC) and less anaemia (RR 0.37, 95% CI 0.15–0.91, p = 0.03 for stages III, IV only NSCLC; p = 0.005 for all stages NSCLC) and neutropenia (RR 0.42, 95% CI 0.22–0.82, p = 0.01 for stages III, IV only NSCLC; p < 0.00001 for all stages NSCLC) when CHM is combined with chemotherapy compared to chemotherapy alone. There was no significant difference in short term effectiveness and limited inconclusive data concerning long term survival. Five promising herbs have been identified.

Conclusion

It is possible that oral CHM used in conjunction with chemotherapy may improve QoL in NSCLC. This needs to be examined further with more rigorous methodology.

Introduction

Lung cancer is a major worldwide health problem and accounts for approximately one sixth of all cancer deaths globally. In the UK lung cancer accounts for around 1 in 7 of new cancer cases, that is, 38,313 new patients diagnosed in 2004 [1]. It is the most common cause of death from cancer for both men and women, and was responsible for 33,465 UK deaths in 2007 accounting for a quarter (24%) of all male and a fifth (19%) of all female cancer deaths [2].

Lung cancer classification describes two broad histological types that account for the majority of diagnosed cases; non-small cell lung cancer (NSCLC 80%) and small cell lung cancer (SCLC 20%). NSCLC can be further sub-divided into squamous cell cancers, adenocarcinoma and large cell carcinoma; these account for approximately 35%, 27% and 10% of all UK lung cancers respectively [3]. The most up to date internationally accepted staging, the Tumour, Node, Metastasis (TNM) of therapeutic interventions by ascribing an accurate prognosis. This staging for lung cancers is described elsewhere [4].

Whilst surgical resection before spread can affect a cure the majority of patients with lung cancer present with disease that is beyond remedial surgical intervention. Consequently surgical resection rates remain low [5], [6] in the UK. Although survival has improved for most cancers this is not the case for lung cancer where 5-year survival rates remain low for decades and are at 6% [7], [8], [9]. Some chemotherapeutic (platinum based) and radiotherapeutic interventions (CHART) have begun to show promise in controlling disease progression. However they are onerous forms of therapy where toxicity and morbidity limit the completion of the recommended number of dose cycles. Adjuvant therapies that might allow patients to complete the full number of dose cycles could therefore have a significant therapeutic impact. For instance Traditional Chinese Medicine (TCM) based interventions such as acupuncture have been utilised to manage adverse reactions to chemotherapy such as nausea [10] Chinese Herbal Medicine (CHM) may also reduce the occurrence of adverse reactions such as anaemia and neutropenia and may offer cheaper and safer options for such strategies than current conventional medication [11]. This systematic review focuses on the use of CHM as an adjuvant treatment for patients receiving chemotherapy for NSCLC.

Our primary research question is

• Does CHM plus chemotherapy show a different survival time when compared to chemotherapy alone for NSCLC patients?

Our secondary research questions are

• What effect does CHM have on the side effect profile of chemotherapeutic interventions in matched patient groups?

• Does CHM have recorded adverse effects?

• Does the addition of CHM improve quality of life (QoL) among those receiving conventional chemotherapy for NSCLC?