Shen-Cao granules formulated based on traditional Chinese medicine alleviates bone marrow suppression caused by platinum-based anticancer reagents

Platelets in the perspective of COVID-19; pathophysiology of thrombocytopenia and its implication as prognostic and therapeutic opportunity

Despite endorsed and exponential research to improve diagnostic and therapeutic strategies, efforts have not yet converted into a better prospect for patients infected with the novel coronavirus (2019nCoV), and still, the name of SARS-CoV-2 is coupled with numerous unanswered questions. One of these questions is concerning how this respiratory virus reduces the number of platelets (PLTs)? The results of laboratory examinations showed that about a quarter of COVID-19 cases experience thrombocytopenia, and more remarkably, about half of these patients succumb to the infection due to coagulopathy. These findings have positioned PLTs as a pillar in the management as well as stratifying COVID-19 patients; however, not all the physicians came into a consensus about the prognostic value of these cells. The current review aims to unravel the contributory role of PLTs s in COVID-19; and also to summarize the original data obtained from international research laboratories on the association between COVID-19 and PLT production, activation, and clearance. In addition, we provide a special focus on the prognostic value of PLTs and their related parameters in COVID-19. Questions on how SARS-CoV-2 induces thrombocytopenia are also responded to. The last section provides a general overview of the most recent PLT- or thrombocytopenia-related therapeutic approaches. In conclusion, since SARS-CoV-2 reduces the number of PLTs by eliciting different mechanisms, treatment of thrombocytopenia in COVID-19 patients is not as simple as it appears and serious cautions should be considered to deal with the problem through scrutiny awareness of the causal mechanisms.

Randomized Efficacy Trial of Conventional, TCM Herb, and TEAS on Bone Marrow Suppression in Patients with Small Cell Lung Cancer after Initial Chemotherapy

Objective

To compare the efficiency of transcutaneous electrical acupoint stimulation (TEAS) with those of conventional and TCM herb on bone marrow suppression in small cell lung cancer (SCLC) patients after initial chemotherapy.

Methods

We recruited 139 participants with pathologically confirmed SCLC who had not received chemotherapy. The conventional group (n = 37) received gemcitabine and cisplatin chemotherapy and routine care. The TCM herb group (n = 35) received 3 Diyushengbai tablets thrice a day for one day prior to chemotherapy and maintained during the trial. The TEAS group (n = 42) received TEAS at a frequency of 65–100 Hz with a pulse width of 100–200 μsec. Acupoints were selected from Dazhui (DU14), Geshu (BL17), Zusanli (ST36), Sanyinjiao (SP6), and Hegu (LI4) and were treated on days 1, 2, 3, 5, 8, 14, 21, and 28 of chemotherapy for 30 min each day. All three groups underwent a 28-day treatment for a total of one treatment course. Changes in the white blood cell, neutrophil, platelet, and hemoglobin indices on day 1 before chemotherapy and days 5, 8, 11, 14, 21, and 28 days after chemotherapy were compared among the groups. Comfort levels of patients on day 1 before chemotherapy and days 5, 11, and 21 after chemotherapy were observed.

Results

Compared with the conventional group, the white blood cell counts in the TEAS group on days 8 (7.07 ± 2.11 vs. 5.97 ± 2.10 × 10⁹/L) and 14 (6.14 ± 1.51 vs. 5.07 ± 2.41 × 10⁹/L) of chemotherapy and that in the TCM herb group on day 14 (6.63 ± 3.44 vs. 5.07 ± 2.41 × 10⁹/L) of chemotherapy were increased (P < 0.05). Compared with the conventional group, the neutrophil count in the TEAS group on days 5 (4.28 ± 1.54 vs. 3.01 ± 1.41 × 10⁹/L), 8 (3.75 ± 1.21 vs. 2.77 ± 1.17 × 10⁹/L), 11 (3.46 ± 1.31 vs. 2.31 ± 1.24 × 10⁹/L), 14 (3.18 ± 1.29 vs. 2.07 ± 1.14 × 10⁹/L), and 21 (4.67 ± 1.31 vs. 3.58 ± 1.23 × 10⁹/L) of chemotherapy and that in the TCM herb group on day 5 (3.88 ± 1.05 vs. 3.01 ± 1.41 × 10⁹/L) of chemotherapy were increased (P < 0.05). Compared with the conventional group, the platelet count of patients in the TEAS group increased on days 5 (264.7 ± 64.1 vs. 201.0 ± 55.7 × 10⁹/L), 8 (251.3 ± 74.9 vs. 188.2 ± 65.8 × 10⁹/L), 11 (236.7 ± 74.9 vs. 181.3 ± 84.3 × 10⁹/L), and 14 (238.3 ± 75.9 vs. 192.8 ± 95.8 × 10⁹/L) of chemotherapy (P < 0.05). Compared with the TCM herb group, the platelet count in the TEAS group increased on days 5 (264.7 ± 64.1 vs. 216.3 ± 57.9 × 10⁹/L), 8 (251.3 ± 74.9 vs. 213.7 ± 70.3 × 10⁹/L), 11 (236.7 ± 74.9 vs. 181.3 ± 84.3 × 10⁹/L), and 21 (254.8 ± 81.8 vs. 213.9 ± 82.6 × 10⁹/L) of chemotherapy (P < 0.05). Compared with the conventional group, the hemoglobin level in the TCM herb group increased on day 14 (135.03 ± 28.06 vs. 122.09 ± 12.63 g/L) of chemotherapy (P < 0.05). Compared with the conventional group, the comfort score of the TEAS group increased on days 5 (78.31 ± 10.21 vs. 70.18 ± 9.34 score) and 11 (80.07 ± 10.44 vs. 72.11 ± 9.47 score) of chemotherapy (P < 0.05).

Conclusion

TEAS is an effective and safe treatment modality for improving bone marrow suppression in SCLC patients after initial chemotherapy. TEAS improved comfort levels more effectively than did conventional and TCM herb.

Investigation on Advanced Non-Small-Cell Lung Cancer among Elderly Patients Treated with Chinese Herbal Medicine versus Chemotherapy: A Pooled Analysis of Individual Data

Purpose

Many patients with advanced non-small-cell lung cancer (NSCLC) seek help from Chinese herbal medicine (CHM). The purpose of this study was to investigate the survival between CHM and chemotherapy (CT) treatment of patients aged ≥60 years with advanced Epidermal Growth Factor Receptor (EGFR) wild type NSCLC and Karnofsky Performance Status (KPS) ≥ 60.

Methods

We extracted individual data of all eligible patients from 1 randomized control trial and 2 cohort studies and performed a pooled analysis. Survival outcomes of patients were compared between CHM group and CT group using Cox regression model stratified for study.

Results

A total of 486 patients were included in the study, including 262 patients in the CHM group and 224 patients in the CT group. The median overall survival time was 10.9 (95% confidence intervals [CI]: 8.9-13.0) months in CHM group and 9.8 (95% CI: 8.1-11.5) days in CT group (p=0.592). The adjusted hazard ratio (HR) and 95% CI for CHM compared to CT are 0.98 (0.87, 1.10, p=0.751) in the stratified Cox regression model. Stratified analysis showed a trend that previously treated elderly patients with EGFR wild type advanced NSCLC probably gain greater survival benefit from CHM (adjusted HR:0.83, 95% CI: 0.68-1.01, p=0.063).

Conclusions

There might be no significant difference in survival for elderly patients with advanced EGFR wild type NSCLC between the CHM and CT groups in the current study. And previously treated elderly patients with advanced NSCLC probably receive greater benefit from CHM. However, limited by the design and unpreplanned study hypothesis, the results must be confirmed by randomized control trial before making a conclusion.