Chinese Medicine Combined With EGFR-TKIs In Treatment Of Stage Ⅲ-Ⅳ Non-small Cell Lung Cancer: Literature Research And Typical Cases

ObjectiveThis article is divided into two parts.The first part: A comprehensive collection of randomized controlled trials of Chinese medicine therapy combined with EGFR-TKIs in the treatment of EGFR-mutant stage III-IV non-small cell lung cancer,collated and merged relevant data,used Rev Man5.3 software for meta-analysis and systematic evaluation The efficacy and safety of Chinese medicine combined with EGFR-TKIs in the treatment of stage III-IV non-small cell lung cancer.The second part: starting from the differentiation of symptoms and signs,extracted 2 relevant cases treated by the tutor,to provided some clinical reference.MethodsRelied upon Cochrane Collaboration search strategy,the literature on traditional Chinese medicine combined with EGFR-TKIs in treatment of stage III-IV non-small cell lung cancer was searched from CNKI,Wanfang Database,VIP database,CBM,Cochrane Library,Embase,Pubmed and other databases.The search scope was from the date of database creation to December 2020.According to the specified criteria,the collected literatures were strictly screened.Carried out quality evaluation on the final inclusion literature,extract relevant data to evaluate the quality of the final inclusion literature.The Rev Man5.3 software was used to conduct a meta-analysis of the main outcome indicators,and systematically evaluate the treatment effect of Chinese medicine combined with EGFR-TKIs.ResultsThrough the combination of computer and manual retrieval,this study retrieved a total of 834 relevant documents,and finally included 26 documents.A total of 2116 patients were observed,including 1078 cases in the treatment group and 1,038 cases in the control group.The included 26 articles of TCM intervention measures include TCM compound,TCM oral preparation or TCM injection.Targeted intervention drugs include first-generation and third-generation EGFR-TKIs(gefitinib,erlotinib,Eke(Tinib,Ositinib);According to Cochrane’s risk of bias assessment criteria,draw a risk of bias map,enter the original data of the observation indicators in the Rev Man5.3software,perform Meta analysis,and perform sensitivity testing if necessary.1.Meta-analysis results show that Chinese medicine combined with EGFR-TKIs can increase the overall response rate(OR),which is better than the EGFR-TKIs group alone.The difference between the two groups was statistically significant [RR=1.25,95%CI(1.16,1.36),Z=5.48,P<0.00001].2.Meta-analysis results show that Chinese medicine combined with EGFR-TKIs can improve the clinical efficacy of disease control rate(DCR)better than the EGFR-TKIs group alone.Better than the simple EGFR-TKIs group.The difference between the two groups was statistically significant [RR=1.14,95%CI(1.08,1.19),P<0.00001].3.Meta-analysis results show that Chinese medicine combined with EGFR-TKIs can prolong progression-free survival(PFS),which is better than the EGFR-TKIs group alone.The difference between the two groups is statistically significant [RR=2.93,95%CI(2.83,3.03)),P<0.00001].4.In terms of overall survival(OS),mate analysis was not performed due to lack of data that met the requirements.5.Meta-analysis results show that the combination of traditional Chinese medicine and EGFR-TKIs has no obvious advantage in the 1-year survival rate compared with EGFR-TKIs alone in the treatment of stage III-IV non-small cell lung cancer.There is no statistical difference between the two groups [RR=1.19,95 %CI(0.99,1.44),Z=1.82,P=0.07>0.05].6.Meta-analysis results show that Chinese medicine combined with EGFR-TKIs can improve the functional status score(KPS score)after treatment,which is better than that of the EGFR-TKIs group alone.The difference between the two groups was statistically significant [RR=6.07,95%CI(5.37,6.77),P<0.00001];7.The results of Meta analysis showed that the combination of traditional Chinese medicine and EGFR-TKIs can stabilize the functional status score(KPS score),which is better than the simple EGFR-TKIs group.The difference between the two groups was statistically significant [RR=1.12,95%CI(1.02,1.23),P=0.02<0.05].8.The results of Meta analysis showed that in terms of the incidence of skin rash,the combination of Chinese medicine and EGFR-TKIs can reduce the occurrence of skin rash,which is better than that of the simple EGFR-TKIs group.The difference between the two groups was statistically significant[RR=0.64,95%CI(0.57,0.72),P<0.00001].The results showed that Chinese medicine combined with EGFR-TKIs can reduce the occurrence of diarrhea.The results of Meta analysis showed that it was superior to the simple EGFR-TKIs group.The difference between the two groups was statistically significant [RR=0.55,95%CI(0.47,0.66),P<0.00001].The results showed that Chinese medicine combined with EGFR-TKIs can reduce the occurrence of liver damage.The results of Meta analysis showed that it was superior to the simple EGFR-TKIs group.The difference between the two groups was statistically significant [RR=0.65,95%CI(0.46,0.92),P=0.02<0.05].ConclusionCombined with the results of the meta-analysis of 26 documents,it can be shown that TCM combined with EGFR-TKIs has a certain effect in the treatment of EGFR-mutant stage III-IV NSCLC.The combination is better than pure targeting in terms of overall remission rate,disease control rate,PFS and improvement of KPS,also can reduce the incidence of skin rash,diarrhea,and liver damage.However,the quality of the literature were not high,and some conclusions did not exclude publication bias,resulting in a lack of evidence strength.Hope that there will be more standardized,high-quality randomized blinded controlled studies in the future to verify the efficacy and safety of the combination of traditional Chinese medicine and EGFR-TKIs.According to the patient’s situation,my tutor focusing on strengthening the body and eliminating evils,and adding and subtracting traditional Chinese medicine to improve the symptoms of the patients,and achieved good clinical effects.