Chinese herbal medicines for induction of remission in advanced or late gastric cancer.

backgroundGastric cancer is difficult to cure once it progresses into an advanced or late stage. Although some chemotherapies or bio-therapies have made progress in the remission of this disease, mortality remains high. A variety of Chinese medicinal herbs have been used to treat gastric cancer.

objectivesTo assess the effectiveness of Chinese medicinal herbs in the short term remission of advanced or late gastric cancer. SEARCH STRATEGY: We searched the Cochrane Library, MEDLINE, EMBASE, AHMED (Allied and Complementary Medicine Database) and CBM (Chinese Biomedical Database) from the first year of the databases to May, 2008. We handsearched a number of journals. SELECTION CRITERIA: All randomised clinical trials of Chinese herbs for advanced or late gastric cancer were included. DATA COLLECTION AND ANALYSIS: Two authors independently extracted the data, which were analysed by RevMan 5.0 software. For dichotomous data, we estimated the relative risk. For continuous data, we calculated the weighted mean difference. MAIN

resultsFifty-five qualified trials with 5261 advanced or late gastric cancer patients were identified, most of which were of low quality and used TCMHs plus chemotherapy compared with the same chemotherapy alone (41 trials). Except for four trials of Huachansu, we could not pool the results because no more than two used the same intervention or outcomes. TCMHs combined with or without chemotherapy in the 51 trials showed statistically significant difference for the improvement of mortality in six trials, quality of life in 13 trials, rate of remission in ten trials, discontinuation from treatment in three trials, leukopenia in one trial, vomiting/nausea in one trial. The pooled results from the four trials of Huachansu showed statistically significant difference for the improvement of leukopenia, but no significant difference for the improvement of adverse events in the digestive system or rate of short-term remission. AUTHORS'

conclusionsThis review did not provide assured evidence concerning the effectiveness of TCMHs in improving the quality of life or rate of remission, alleviating the toxic and side effects caused by the chemotherapy, or reducing short-term mortality. Limited and weak evidence showed that Huachansu, when used together with chemotherapy, improved leukopenia caused by chemotherapy, but did not improve rate of short-term remission. Large, well designed clinical trials are required urgently before any confident conclusions can be drawn about the value of TCMHs for advanced or late gastric cancer.