The Hepatorenal Toxicity and Tumor Response of Chemotherapy With or Without Aidi Injection in Advanced Lung Cancer: A Meta-Analysis of 80 Randomized Controlled Trials

• Published in: Clinical therapeutics Vol. 42; no. 3; pp. 515 - 543.e31
• Main Authors: Xiao, Zheng, Jiang, Yuan, Chen, Xiao-Fan, Wang, Cheng-Qiong, Xu, Wei-hong, Liu, Yao, Hu, Shan-Shan, Huang, Xiao-Rong, Shan, Li-Jing, Tang, Yu-Hong, Yang, Yi-Bin, Feng, Ji-Hong, Xiao, Xue, Li, Xiao-Fei
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2020; Elsevier Limited
• Subjects: Aidi injection; Bias; Cancer therapies; Chemotherapy; Chinese medicine; Clinical trials; Disease control; Drug dosages; Evaluation; Handbooks; Hepatotoxicity; individualized management strategy; Injection; Lung cancer; Medical prognosis; Meta-analysis; nephrotoxicity; non–small cell lung cancer (NSCLC); Quality; Quality of life; Radiation therapy; Randomization; Risk; Subgroups; Toxicity; Tumors; China; meta-analysis; individualized management strategy; nephrotoxicity; non–small cell lung cancer (NSCLC); Aidi injection; hepatotoxicity
• ISSN: 0149-2918; 1879-114X
• DOI: 10.1016/j.clinthera.2020.01.011

Chemotherapy-induced hepatorenal toxicity often decreases tolerance for further therapies and results in poor quality of life and prognosis for patients with lung cancer. In this meta-analysis, all related studies were systematically re-evaluated to determine whether Aidi injection relieves hepatorenal toxicity and improves tumor response, and to determine its threshold and the optimal treatment regimen for obtaining the desired responses. All studies regarding Aidi injection with chemotherapy were gathered from Chinese and English databases (from inception until January 2019). Their bias risk was evaluated and the data were synthesized using meta-analysis; the quality of evidence of all outcomes was rated by using the Grades of Recommendation Assessment, Development, and Evaluation approach. Eighty randomized controlled trials containing 6279 patients were included in the study. Most of the trials showed unclear risk of bias. Aidi injection with chemotherapy increased the objective response rate (risk ratio [RR], 1.32; 95% CI, 1.25–1.40) and the disease control rate (RR, 1.15; 95% CI, 1.12–1.17) and resulted in a lower incidence of hepatotoxicity (RR, 0.61; 95% CI, 0.55–0.69) and nephrotoxicity (RR, 0.62; 95% CI, 0.53–0.72) than that of chemotherapy alone. Subgroup analyses showed that treatment with 50 mL per time, 10 to 14 days per cycle, and 2 to 3 cycles of Aidi injection with chemotherapy resulted in a low incidence of hepatorenal toxicity. All of the results were robust, and their quality was moderate. The moderate evidence indicates that Aidi injection with chemotherapy may improve tumor response and result in a low incidence of hepatorenal toxicity in patients with lung cancer. Aidi injection may relieve hepatorenal toxicity and exhibit an important protective effect against chemotherapy-induced hepatorenal toxicity. Based on the subgroup analysis results, Aidi injection seems to lower the threshold for chemotherapy. Treatment with 50 mL per time, 10 to 14 days per cycle, and 2 to 3 cycles may be the optimal usage for attaining a decrease in hepatorenal toxicity. [Display omitted]