Chinese herbal medicine for epidermal growth factor receptor inhibitor-induced skin rash in patients with malignancy: An updated meta-analysis of 23 randomized controlled trials

Zhi-Qiang Chen; Ze-Yun Li; Cai-Zhi Yang; Rui-Ting Lin; Li-Zhu Lin; Ling-Ling Sun

doi:10.1016/j.ctim.2019.08.001

Chinese herbal medicine for epidermal growth factor receptor inhibitor-induced skin rash in patients with malignancy: An updated meta-analysis of 23 randomized controlled trials

Complement Ther Med. 2019 Dec:47:102167. doi: 10.1016/j.ctim.2019.08.001. Epub 2019 Sep 9.

Authors

Zhi-Qiang Chen¹, Ze-Yun Li¹, Cai-Zhi Yang¹, Rui-Ting Lin¹, Li-Zhu Lin², Ling-Ling Sun³

Affiliations

¹ The First Clinical School of Guangzhou University of Chinese Medicine, Guangzhou 510405, China.
² The First Clinical School of Guangzhou University of Chinese Medicine, Guangzhou 510405, China; The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China. Electronic address: lizhulin26@yahoo.com.
³ The First Clinical School of Guangzhou University of Chinese Medicine, Guangzhou 510405, China; The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou 510405, China. Electronic address: lingling.sun2017@gmail.com.

PMID: 31780021
DOI: 10.1016/j.ctim.2019.08.001

Abstract

Objective: To systematically review and evaluate the effectiveness of Chinese herbal medicine (CHM) therapy for epidermal growth factor receptor inhibitor (EGFRI)-induced skin rash in patients with malignancy.

Methods: The electronic databases of Medline, PubMed, EMBASE, the Cochrane Library, China National Knowledge Infrastructure, VIP Chinese Sci-tech Journal, Wan Fang, and Chinese Biomedicine were searched from their inception to 31 st September 2018. Randomized controlled trials (RCTs) investigating the effectiveness of CHM in improving EGFRI-induced skin rash were analyzed by Review Manager 5.3.

Results: Twenty-three eligible RCTs with 1392 participants were identified and divided into four subgroups according to different treatment rules of Traditional Chinese Medicine (TCM) and different controls. CHM (dispel wind, clear heat, and eliminate dampness), the representative formula Xiao Feng San, is more effective than western medicine in improving and curing skin rash(RR,95%CI: 1.46,1.26-1.70 and 1.65,1.24-2.20); CHM (nourish yin, clear heat, and remove toxin for eliminating blood stasis), the representative formula Yang Fei Xiao Zhen Tang, is more effective than western medicine in improving skin rash(RR,95%CI: 1.45,1.10-1.92). CHM (clear lung and purge heat, cool blood, and remove toxic substance) is more effective in improving and curing skin rash, compared with the western medicine group (RR,95%CI: 1.42,1.21-1.67 and 2.43,1.23-4.81) or the blank control group(RR,95%CI:2.37,1.21-4.63 and 2.98,1.20-7.41). The side effects of CHM are all mild and tolerable. Sensitivity analysis indicates that the results of the study are stable. The asymmetry funnel plots described that publication bias of this research may exist.

Conclusion: The limited evidence suggests that CHM exhibits clinical effectiveness and good safety on the treatment of EGFRI-induced skin rash. Large-sample RCTs are required to further determine the effectiveness of CHM.

Keywords: Chinese herbal medicine; Epidermal growth factor receptor inhibitor; Meta-analysis; Skin rash; Traditional Chinese medicine.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Antineoplastic Agents / adverse effects*
Drugs, Chinese Herbal / therapeutic use*
ErbB Receptors / antagonists & inhibitors*
Exanthema / chemically induced*
Exanthema / drug therapy*
Humans
Medicine, Chinese Traditional
Neoplasms / drug therapy*
Randomized Controlled Trials as Topic

Substances

Antineoplastic Agents
Drugs, Chinese Herbal
ErbB Receptors