Chinese medical herbs for chemotherapy side effects in colorectal cancer patients

Wu T, Munro AJ, Guanjian L, Liu GJ

Published Online:

October 8, 2008

Chinese herbal medicines are widely used to counteract the side-effects of chemotherapy in patients being treated for cancer. As yet, there is no clear evidence that herbal medicines are effective in this role. We have performed a systematic review of the potential benefits of Chinese herbal medicines in patients being treated with chemotherapy for colorectal cancer. We identified four relevant studies, which included a total of 342 patients, with adequately reported data. We conclude that, from the limited information available, there is some evidence of benefit from decoctions of Huangqi compounds. Compared with patients treated by chemotherapy alone, patients treated with chemotherapy and Huangqi decoctions were less likely to experience nausea and vomiting or low white cell counts. There was some evidence to suggest that the decoctions also stimulated cells of the immune system, but did not affect the levels of antibodies in the blood. We could find no evidence of harm arising from the use of Huangqi decoctions. Our results suggest that further, larger-scale, trials of the use of Huangqi decoctions in the prevention of chemotherapy-related side-effects are needed.

Abstract (click to read)

Background:

Side effects, including nausea and vomiting, sore mouth , diarrhoea, hepatotoxicity, myelosuppression, and immunosuppression , are commonly encountered in patients with colorectal cancer who are treated with chemotherapy. A variety of Chinese herbal medicines have been used for managing these adverse effects.

Objectives:

To assess the effect of herbal medicines plus chemotherapy, compared with chemotherapy alone, on the side effects of chemotherapy on the quality of life, and on adverse events in patients with colorectal cancer.

Search strategy:

We searched the Cochrane Library, MEDLINE, EMBASE, CBM, and handsearched the relevant Chinese journals.

Selection criteria:

Randomised trials comparing either chemotherapy only or chemotherapy plus anti-emetics (tropisetron, sulpiride etc) with chemotherapy plus Chinese herbs.

Data collection and analysis:

Trial quality was assessed independently by two reviewers. Data were extracted by one reviewer and checked by the second reviewer. Since the four included studies differed significantly in design, we could only perform limited meta-analyses. We have therefore presented the majority of the data in narrative form.

Main results:

We included four relevant trials. All of them were of low quality. All of studies used a decoction containing Huangqi compounds as the intervention with chemotherapy. The intervention groups of three studies were compared to a chemotherapy alone control group, the fourth study compared the decoction of Huangqi compounds with two other Chinese herbal interventions. None of the studies reported on primary outcome using Common Toxicity Criteria (CTC). There was a significant reduction in the proportion of patients who experienced nausea & vomiting when decoctions of Huangqi compounds were given in addition to chemotherapy. There was also a decrease in the rate of leucopenia (WBC <3 x 10^9 per L). Huangqi compounds were also associated with increases in the proportions of T-lymphocyte subsets: CD3; CD4 and CD8. Huangqi decoctions had no significant effects on Immunoglobulins G, A or M.

Authors' conclusions:

Despite the included studies being of low quality, the results suggest that decoctions of Huangqi compounds may stimulate immunocompetent cells and decrease side effects in patients treated with chemotherapy. Due to the methodological limitations of the studies, there is no robust demonstration of benefit. We found no evidence of harm arising from the use of Chinese herbs. We need high quality randomised controlled studies investigating the effects of decoctions of Chinese herbs, particularly Astragalus spp.(as in Huangqi), upon chemotherapy-related side effects.

This record should be cited as:

Wu T, Munro AJ, Guanjian L, Liu GJ. Chinese medical herbs for chemotherapy side effects in colorectal cancer patients. Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD004540. DOI: 10.1002/14651858.CD004540.pub2

Assessed as up to date:

November 9, 2004

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Primary Review Group:

Colorectal Cancer Group

Health topics:

Cancer > Colorectal > Medical & adjuvant therapy

Gastroenterology > Cancer: colorectal > Medical & adjuvant therapy

Gastroenterology > Non-neoplastic disease of the small & large bowel > Peritonitis

Complementary & alternative medicine > Cancer > Colorectal

Complementary & alternative medicine > Gastroenterology > Cancer