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大腸癌患者における化学療法の副作用に対する中薬(中医学の薬草療法)

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Abstract

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Background

Side effects, including nausea and vomiting, sore mouth , diarrhoea, hepatotoxicity, myelosuppression, and immunosuppression , are commonly encountered in patients with colorectal cancer who are treated with chemotherapy. A variety of Chinese herbal medicines have been used for managing these adverse effects.

Objectives

To assess the effect of herbal medicines plus chemotherapy, compared with chemotherapy alone, on the side effects of chemotherapy on the quality of life, and on adverse events in patients with colorectal cancer.

Search methods

We searched the Cochrane Library, MEDLINE, EMBASE, CBM, and handsearched the relevant Chinese journals.

Selection criteria

Randomised trials comparing either chemotherapy only or chemotherapy plus anti‐emetics (tropisetron, sulpiride etc) with chemotherapy plus Chinese herbs.

Data collection and analysis

Trial quality was assessed independently by two reviewers. Data were extracted by one reviewer and checked by the second reviewer. Since the four included studies differed significantly in design, we could only perform limited meta‐analyses. We have therefore presented the majority of the data in narrative form.

Main results

We included four relevant trials. All of them were of low quality. All of studies used a decoction containing Huangqi compounds as the intervention with chemotherapy. The intervention groups of three studies were compared to a chemotherapy alone control group, the fourth study compared the decoction of Huangqi compounds with two other Chinese herbal interventions. None of the studies reported on primary outcome using Common Toxicity Criteria (CTC). There was a significant reduction in the proportion of patients who experienced nausea & vomiting when decoctions of Huangqi compounds were given in addition to chemotherapy. There was also a decrease in the rate of leucopenia (WBC <3 x 10^9 per L). Huangqi compounds were also associated with increases in the proportions of T‐lymphocyte subsets: CD3; CD4 and CD8. Huangqi decoctions had no significant effects on Immunoglobulins G, A or M.

Authors' conclusions

Despite the included studies being of low quality, the results suggest that decoctions of Huangqi compounds may stimulate immunocompetent cells and decrease side effects in patients treated with chemotherapy. Due to the methodological limitations of the studies, there is no robust demonstration of benefit. We found no evidence of harm arising from the use of Chinese herbs. We need high quality randomised controlled studies investigating the effects of decoctions of Chinese herbs, particularly Astragalus spp.(as in Huangqi), upon chemotherapy‐related side effects.

一般語訳

大腸癌患者における化学療法の副作用に対する中薬(中医学の薬草療法)

中薬(中医学の薬草療法)は癌の化学療法を受けている患者の副作用を弱めるために広く用いられている。しかし、中薬がこの役割おいて効果的であるかの明らかなエビデンスはない。大腸癌の化学療法を受けている患者に対する中薬の潜在的な利益においてシステマティック・レビューを行った。関連する計342例の患者を対象とした4件の試験で、適切に報告されたデータのある試験を同定した。限られた情報によると、オウギの湯剤(煎じ薬)に利益があるとするいくつかのエビデンスがあると結論づけた。化学療法のみで治療された患者と比較して、化学療法およびオウギ湯剤の治療を受けた患者は、吐き気および嘔吐または白血球数減少を経験する可能性が低い傾向にあった。なかには、湯剤が免疫システムの細胞を賦活するが、血中の抗体値には影響しないことを示唆するエビデンスがあった。オウギ湯剤の使用による有害性のエビデンスはみられなかった。これらの結果から、化学療法に関連する副作用の予防に対してオウギ湯剤を用いたさらに大規模な試験の必要性が示唆された。