Oral Chinese herbal medicine as maintenance treatment after chemotherapy for advanced non-small-cell lung cancer: a systematic review and meta-analysis

Background The concept of maintenance therapy in cancer treatment is currently under debate because of modest survival benefits, added toxicity, economic considerations, and quality-of-life concerns. Traditional Chinese Medicine (TCM) is widely used in China for cancer patients, offering the advantages of low toxicity and enhancement of quality of life. However, no systematic reviews or meta-analyses have assessed the role of tcm as maintenance treatment for non-small-cell lung carcinoma. Methods We searched the Chinese Biomedical Literature Database, the China National Knowledge Infrastructure, PubMed, EMBASE, and the Cochrane Library databases for all eligible studies. The endpoints were overall survival (os), progression-free survival (PFS), the 1-year and 2-year survival rates, and performance status. Our meta-analysis used a fixed-effects model and a random-effects model for heterogeneity in the Stata software application (version 11.0: StataCorp LP, College Station, TX, U. S. A.), with the results expressed as hazard ratios (HRS) or risk ratios (RRS), with their corresponding 95% confidence intervals (95% CIS). Results Sixteen randomized studies representing 1150 patients met the inclusion criteria. Compared with best supportive care, observation, or placebo, tcm as maintenance treatment was associated with a significant increase in os (HR: 0.49; 95% CI: 0.35 to 0.68; p < 0.001), PFS (HR: 0.66; 95% CI: 0.51 to 0.84; p = 0.001), and 2-year survival rate (RR: 0.63; 95% CI: 0.44 to 0.92, p = 0.017), and a significant improvement in performance status (RR: 0.68; 95% CI: 0.61 to 0.75; p < 0.001). Conclusions For patients who show non-progression-including stable disease, partial response, or complete response-after first-line chemotherapy, including those with poor quality of life, oral Chinese herbal medicine can be considered an efficient and safe maintenance therapy strategy.