Chinese herbal injections combined with EGFR-TKIs for intervention of non-small cell lung cancer: a systematic review and meta-analysis

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Abstract
Objective: To serve as a clinical reference, we conducted a meta-analysis to assess and compare the efficacy and safety of combining Chinese herbal injections (CHIs) with epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) for treating advanced EGFR-mutated non-small cell lung cancer (NSCLC). Methods: Predetermined databases contained randomized controlled studies comparing CHIs + EGFR-TKIs to EGFR-TKIs alone. The Cochrane Reviewer’s Handbook for Systematic Reviews of Interventions was used to evaluate study methodology. To assess the effects of CHIs on patients with NSCLC receiving EGFR-TKIs, R (version 4.4.0) and RevMan (version 5.4) were used to conduct a meta-analysis using the Mantel–Haenszel or Inverse Variance method. The quality of results was evaluated using the Grade of Recommendations Assessment, Development and Evaluation (GRADE) method. Results: The 13 qualifying trials included 899 subjects. The objective response rate (ORR) was significantly increased by Kanglaite injection (RR = 1.52, 95% confidence interval [CI]: 1.07–2.15, p = 0.02). The disease control rate (DCR) was influenced by Kanglaite injection (RR = 1.14, 95% CI: 1.01–1.29, p = 0.04) and Aidi injection (RR = 1.23, 95% CI: 1.02–1.48, p = 0.03). Shenmai injection + EGFR-TKIs reduced dermatologic toxicities (RR = 0.35, 95% CI: 0.18–0.69, p = 0.002). The combination of CHIs with EGFR-TKIs improved the expression of CD3 + (standardized mean difference [SMD] = 1.38, 95% CI: 0.46–2.30, p = 0.003), CD4 + (SMD = 1.08, 95% CI: 0.51–1.65, p = 0.0002), and the CD4 + /CD8 + ratio (SMD = 0.96, 95% CI: 0.54–1.38, p < 0.00001) compared to EGFR-TKIs alone. The GRADE method revealed that most outcomes exhibited low certainty evidence. Conclusion: The combination of CHIs and EGFR-TKIs improved ORR, DCR, adverse effects, and immune function in patients with NSCLC. Due to limitations in the assessed research, high-quality clinical studies with rigorous designs are required to confirm the findings. Systematic Review: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024561845, Identifier CRD42024561845.
Funding Information
  • Chinese Association of Integrative Medicine (CACMLHJJ-20220102)

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