Has aidi injection the attenuation and synergistic efficacy to gemcitabine and cisplatin in non-small cell lung cancer? A meta-analysis of 36 randomized controlled trials

// Zheng Xiao 1, 2 , Chengqiong Wang 1, 2 , Ling Chen 1, 2 , Xuemei Tang 7 , Lianhong Li 7 , Nana Li 1, 2 , Jing Li 1, 5 , Qihai Gong 3 , Fushan Tang 3 , Jihong Feng 4 , Xiaofei Li 6 1 Evidence-Based Medicine Center, MOE Virtual Research Center of Evidence-based Medicine at Zunyi Medical College, Affiliated Hospital of Zunyi Medical College, Zunyi 563003, Guizhou, China 2 Department of Respiratory Medicine (Center for Evidence-Based and Translational Medicine of Major Infectious Diseases), Affiliated Hospital of Zunyi Medical College, Zunyi 563003, Guizhou, China 3 School of pharmacy, Zunyi Medical College, Zunyi 563003, Guizhou, China 4 Department of Oncology, Affiliated Hospital of Zunyi Medical College, Zunyi 563000, Guizhou, China 5 Department of Neurology, First People’s Hospital of Zunyi City and Third Affiliated Hospital of Zunyi Medical College, Zunyi 563002, Guizhou, China 6 Department of Parasites, Zunyi Medical College, Zunyi 563003, Guizhou, China 7 Grade 2012 students, Department of Public Health, Zunyi Medical College. Zunyi 563002, Guizhou, China Correspondence to: Zheng Xiao, email: zy426f@163.com Keywords: aidi injection, non-small cell lung cancer (NSCLC), gemcitabine and cisplatin (GP), randomized controlled trial, meta-analysis Received: July 27, 2016 Accepted: November 07, 2016 Published: November 25, 2016 ABSTRACT Gemcitabine and cisplatin is the first line chemotherapy for non-small cell lung cancer with high toxicity. Aidi injection is a cantharidin and astragalu-based Chinese herbs injection in China. Has Aidi injection attenuation and synergistic efficacy to GP in NSCLC? There is lack of strong evidence to prove it. To further reveal it, we systematically evaluated all related studies. We collected all studies about Aidi injection plus GP for NSCLC in Medline, Embase, Web of Science, CNKI, VIP, Wanfang Database, CBM, CCRCT, Chi-CTR, and US-clinical trials (established to June 2015). We evaluated their quality according to the Cochrane evaluation handbook of randomized controlled trials (5.1.0), extracted data following the PICO principles and synthesized the data by Meta analysis. Thirty six RCTs with 2582 NSCLC patients were included, with general methodological quality in most trials. The RR values and their 95% CI of Meta-analysis for ORR, DCR and QOL were as following: 1.28 (1.17, 1.39), 1.11(1.07, 1.15) and 1.81 (1.61, 2.03). The merged RD values and their 95% CI of Meta-analysis for myelosuppression, neutropenia, thrombocytopenia, neurotoxicity and nausea and vomiting were as following : -0.23(-0.29, -0.17), -0.17(-0.22, -0.11), -0.13(-0.18, -0.08), -0.06(-0.17, 0.05) and -0.15(-0.21, -0.10). To compare with GP alone, all differences were statistically significant. The available evidence indicates that Aidi injection plus GP can significantly increase the clinical efficacy and improve the QOL of patients with NSCLC. Aidi injection can reduce myelosuppression, neutropenia, thrombocytopenia neurotoxicity and nausea/vomiting. These indirectly reveal that Aidi injection has the attenuation and synergistic efficacy to GP chemotherapy in NSCLC.