Effect of Huisheng oral solution on coagulation function in perioperative period in patients with primary lung cancer

A retrospective study on the effect of Chinese patent medicine combined with conventional treatment on the survival outcomes of 313 patients with stage II-III NSCLC

PURPOSE

We aim to explore the effect of Chinese Patent Medicine (CPM), including Huisheng oral solution (HSOS) on the 4-year survival rate of patients with stage II and III non-small cell lung cancer, and assess the association between blood coagulation indicators and survival outcomes.

MATERIALS AND METHODS

313 patients diagnosed with stage II and III NSCLC were collected during 2015-2016. Kaplan-Meier method and Cox proportional hazard model were applied to analyze the factors affecting the 4-year survival rate of patients.

RESULTS

According to the effect of CPM, the medicine prescribed in this study could be classified into two types. The proportion of patients who received "Fuzheng Quyu" CPM for more than three months was higher than the proportion of patients who received other two types of CPM for more than three months. Medical records of 313 patients with NSCLC were analyzed. 4-year survival rate for patients received CPM more than 6 months and 3 months were higher than those received CPM less than 3 months (P = 0.028 and P = 0.021 respectively. In addition, 4-year survival rate for patients who received HSOS for more than 3 months was higher than those who received HSOS for less than 3 months (P = 0.041). Patients with elevated preoperative fibrinogen (FIB) level and those without surgery had an increased mortality risk (HR = 1.98, P < 0.01, and HR = 2.76, P < 0.01 respectively).

CONCLUSION

The medium and long-term use of CPM/HSOS was positively associated with higher survival rate in NSCLC patients. Patients with high-level preoperative FIB level and those without surgery might have a poor prognosis in the following years.

Treatment of Lung Cancer with Orally Administered Chinese Herbal Medicine: An Evidence Map between 1970-2020

OBJECTIVE

Through showing the full picture of double-arm controlled clinical research and systematic review evidence in the field of orally administrated Chinese herbal medicine (CHM) for treatment of lung cancer, to provide a reference for future clinical research and to indicate a direction for future systematic reviews.

METHODS

A comprehensive search of clinical controlled studies was performed regarding orally administered CHM treatment for lung cancer published from January 1970 to September 2020. The language was restricted to Chinese and English. Relevant data were extracted, the quality of systematic reviews was evaluated, and the research evidence was visually displayed.

RESULTS

Randomized controlled trials were the most common type of research design. The research sample sizes were typically small. Oral CHM showed certain curative advantages in treating lung cancer. The key stages in oral CHM intervention for lung cancer are chemotherapy, radiotherapy, and late palliative treatment. The advantageous outcomes of oral CHM treatment of lung cancer are the short-term efficacy, quality of life, and adverse reactions. The perioperative stage, overall survival, pharmacoeconomic evaluation, and Chinese medicine decoctions are weak research areas.

CONCLUSIONS

CHM has staged and therapeutic advantages in treating lung cancer. The overall methodological quality is poor, and the level of evidence requires improvement. It is necessary to carry out large-scale, standardized, and higher-quality research in the superior and weak areas of CHM treatment of lung cancer.

Zi Shen Decoction Inhibits Growth and Metastasis of Lung Cancer via Regulating the AKT/GSK-3β/β-Catenin Pathway

Lung cancer has become the leading cause of cancer-related death worldwide. Oxidative stress plays important roles in the pathogenesis of lung cancer. Many natural products show antioxidative activities in cancer treatment. Zi Shen decoction (ZSD) is a classic prescription for the treatment of lung disease. However, its effect on lung cancer lacks evidence-based efficacy. In this study, we investigated the anticancer effects of ZSD on lung cancer in vivo and in vitro. Our results showed that oral administration of ZSD suppressed the Lewis lung cancer (LLC) growth in a subcutaneous allograft model and promoted necrosis and inflammatory cell infiltration in the tumor tissues. Furthermore, ZSD not only inhibited tumor cell proliferation and migration but also induced cell apoptosis in lung cancer cells. PI3K/AKT signaling is well characterized in response to oxidative stress. The bioinformatics analysis and western blot assays suggested that ZSD decreased the enzyme activity of PI3K and AKT in vivo and in vitro. We also found that the AKT/GSK-3β/β-catenin pathway medicated anticancer effect of ZSD in lung cancer cells. In conclusion, we demonstrate for the first time that ZSD possesses antitumor properties, highlighting its potential use as an alternative strategy or adjuvant treatment for lung cancer therapy.

Huisheng Oral Solution Adjunct With Platinum-Based Chemotherapy for the Treatment of Advanced Non-Small Cell Lung Cancer: A Meta-Analysis and Systematic Review

Background

Platinum-based chemotherapy is one of the first line therapies for the advanced non–small cell lung cancer (NSCLC), even though its high toxicity and limited clinical effects cannot be neglected. Huisheng oral solution (HSOS) has been widely used as an adjuvant chemotherapy drug for NSCLC in China. To systematically analyze the therapeutic effects of the combination of HSOS and platinum-based chemotherapy, a comprehensive meta-analysis was performed.

Objectives

This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of HSOS for NSCLC.

Methods

The randomized controlled trials (RCTs) were selected on seven medical databases up to June 2020, including advanced NSCLC treatment using HSOS plus platinum-based chemotherapy versus chemotherapy alone. We followed the PRISMA checklist in general, applying Cochrane handbook 5.1.0, GRADE Pro GDT, RevMan 5.3, Stata12.0, and TSA 0.9.5.10 Beta to evaluate the quality of the study and analyze the data.

Results

Based on Cochrane handbook 5.1.0, 15 RCTs consisting 1165 patients met the criteria and were selected for further analysis. Compared to chemotherapy alone, the chemotherapy combined with HSOS significantly improved objective tumor response (ORR) [RR = 1.38, 95% CI (1.19, 1.59), P < 0.0001], disease control rate (DCR) [RR = 1.10, 95% CI (1.04, 1.16), P = 0.0006], and Karnofsky performance status (KPS) [RR = 1.79, 95% CI (1.41, 2.26), P < 0.00001]. However, there was no evidence of improvement in the 1-year survival rate [RR = 1.37, 95% CI (0.98, 1.92), P = 0.07]. In terms of the side effects, HSOS administered concurrently with chemotherapy resulted in a serial of substantial benefits: lower toxicity to white blood cell [RR = 0.30, 95% CI (0.20, 0.43), P < 0.00001], lower platelet toxicity [RR = 0.56, 95% CI (0.34, 0.92), P = 0.02], and reduced incidence of vomiting [RR = 0.52, 95% CI (0.29, 0.92), P = 0.03].

Conclusions

The meta-analysis indicated that HSOS plus platinum-based chemotherapy was more beneficial for patients, as the therapy could synergize antitumor activity and could attenuate toxicity. The finding requires confirmation by further rigorously designed RCTs.

Lung Cancer and Pulmonary Embolism: What Is the Relationship? A Review

Pulmonary embolism (PE) is gradually considered to be the third most common disease in the vascular disease category. Lung cancer is the most frequently diagnosed cancer and the leading cause of cancer death among males worldwide. Although initially appearing as distinct entities, lung cancer is a great risk factor for the development of PE. Pulmonary embolism is common in lung cancer patients, with a pooled incidence of 3.7%, and unsuspected pulmonary embolism (UPE) is also non-negligible with a rough rate ranging from 29.4% to 63%. Many risk factors of PE have been detected and could be classified into three categories: lung cancer-related, patient-related, and treatment-related factors. Decreased mean survival time could be significantly observed in lung cancer patients with PE or UPE compared to those only, but suspected PE has higher mortality than UPE. Prophylactic anticoagulant therapy benefit might be highest in patients with stage IV non-small cell lung cancer (NSCLC) or limited small cell lung cancer (SCLC), and heparin seems superior to warfarin for thrombotic prophylaxis. Periodically reassessing the risk-benefit ratio of anticoagulant treatment will be an efficient treatment strategy in lung cancer patients with PE.