Aidi injection plus platinum-based chemotherapy for stage IIIB/IV non-smallcell lung cancer: A meta-analysis of 42 RCTs following the PRISMA guidelines
Globally, lung cancer remains the most common cancer and the leading cause of cancer death. In the United States, death from lung cancer accounts for approximately
25% of all cancer deaths, and 234,030 new lung cancer cases, 154,050 lung cancer deaths are projected to occur in 2018. In China, there were 732,800 new lung cancer cases and 590, 700 lung cancer deaths in 2013. In Macau, the most common cause of cancer death is also lung cancer, which takes up 32% and 24% of cancer mortality in males and females respectively.
About 85% of lung cancers are non-small cell lung cancer (NSCLC) and most of newly diagnosed cases of NSCLC are at stage IIIB/IV.For patients with stage IIIB/IV NSCLC, platinum-based chemotherapy (PBC) is considered the standard of care and the most common first-line therapy, which usually consists of platinum compounds (cisplatin, nedaplatin, carboplatin, or oxaliplatin,etc.) and third-generation chemotherapy agents (docetaxel,paclitaxel, vinorelbine, or gemcitabine, etc.).
However, despite all efforts at management, the prognosis of stage IIIB/IV NSCLC remains poor with a median survival of 7.9 months, a 1-year survival rate of 33%, and a 2- year survival rate of 11%. In China, besides PBC, traditional Chinese medicine has been widely used in the treatment of advanced NSCLC. Aidi injection (Aidi) is one of the anti-tumor Chinese patent medicines, increasingly prescribed as an adjunct therapy for NSCLC. It is made from an extraction of Mylabris Phalerata (Banmao), Radix Astragali [Astragalus membranceus (Fisch.) Bge. root, Huangqi], Radix Ginseng (Panax ginseng C.A.Mey., root, Renshen), Acanthopanax Senticosus [Acanthopanax senticosus (Rupr. & Maxim.) Harms, Ciwujia]. Active compounds of Aidi injection include cantharidin, astragalosides, ginsenosides, isofraxidin, and syringin, etc.,and various studies have shown that Aidi possesses the following pharmacological effects: (1) anti-tumor activity; (2) immune regulatory action
; (3) reducing adverse events induced by chemotherapy.Some trials suggested that Aidi combined with platinum-based chemotherapy might bring beneficial effects to the sufferers with advanced NSCLC, but, unfortunately, the conclusion is still controversial in different studies.Several meta-analyses have evaluated the effects of Aidi combined with some specific chemotherapy regimens for NSCLC,but the efficacy and safety of Aidi plus PBC for stage IIIB/IV NSCLC have not been systematically evaluated.Anatomic staging is the most significant prognostic factor,
therefore, there is a need to further evaluate this therapy for NSCLC at stage IIIB/IV, thus helping guide clinicians in making optimal, stage-specific treatment decision for the homogeneous patient subsets.
In this study,42 RCTs recruiting 4081 patients with stage IIIB/IV NSCLC were included, with overall low-moderate methodological quality. Compared with platinum-based chemotherapy alone, Aidi injection plus platinum-based chemotherapy can increase relative benefit of Disease Control Rate(DCR) (RR = 1.13, 95% CI 1.09–1.16, P < 0.00001), Objective Response Rate(ORR) (RR =1.26, 95% CI 1.18–1.36, P < 0.00001), improve 1-, 2-, 3-year survival rates (RR = 1.14, 95% CI 1.02–1.28,P=0.03; RR = 1.31, 95% CI 1.05–1.64, P=0.02; and RR = 1.88, 95% CI 1.32–2.67, P=0.0005, respectively),quality of life(QOL) (RR = 1.80, 95% CI 1.61–2.01, P < 0.00001), and reduce severe (grade 3 and 4) toxicities by 36%(RR = 0.64, 95% CI 0.58–0.70, P < 0.00001).
we evaluated the efficacy and safety of Aidi injection in combination with platinum-based chemotherapy for stage IIIB/IV NSCLC.From the available evidence, compared with platinum-based chemotherapy alone, Aidi injection plus platinum-based chemotherapy improves the clinical efficacy and alleviates the toxicity of chemotherapy in patients with stage IIIB/IV NSCLC. However, considering the intrinsic limitations of the included RCTs, welldesigned,rigorously performed, high-quality trials are still required to further assess and confirm the results.This paper was published by the journal“Journal of Ethnopharmacology”, 15 July 2018.The newly released Impact Factor forJournal of Ethnopharmacologyis 3.115 (Clarivate Analytics, 2018).