The Systematic Review Of Traditional Chinese Medicine Combined With EGFR-TKIs In The Treatment Of Middle To Late Stage Non-small-cell Lung Carcinoma With EGFR Mutations

ObjectiveTo systematically and comprehensively collect all randomized controlled studies related to the combination of traditional Chinese medicine and EGFR-TKIs in the treatment of EGFR-mutant advanced non-small-cell lung cancer,screen out the documents that meet the quality standards,and perform meta analysis and quantitative synthesis on the data,to evaluate the efficacy of Chinese medicine combined with EGFR-TKIs in the treatment of EGFR mutant advanced non-small cell lung cancer.MethodsUsing a combination of computer and manual search,formulate a search strategy based on the search specifications provided by the Cochrane Collaboration,Search literature from China Biomedical Literature Database(CBM),China Knowledge Network(CNKI),Wanfang Data,VIP Database,Cochrane Library Clinical Controlled Trial Database(CENTRAL),Embase,MEDLINE,Pubmed.all literatures related to the combination of traditional Chinese medicine and targeted therapy for non-small cell lung cancer fromthe establishment of the library to January 2020.and according to the established document inclusion and exclusion criteria,the collected documents were strictly screened and data extracted.The quality of the finally determined included literature was evaluated.RevMan5.3 software was used for meta-analysis of relevant outcome indicators to evaluate the efficacy of traditional Chinese medicine combined with targeted treatment of EGFR mutant advanced non-small cell lung cancer.ResultsA total of 1079 articles were retrieved.After rigorous screening,21 articles were finally included.A total of 1586 patients were observed,including 806 in the treatment group and780 in the control group.The traditional Chinese medicine interventions in 21 articles include Traditional Chinese medicine compound,traditional Chinese medicine oral preparation or traditional Chinese medicine injection,and the western medicine targeted therapies are first-generation EGFR-TKIs(gefitinib,erlotinib,icotinib);according to the bias risk assessment standard provided by the Cochrane Handbook 5.1.0,draw the bias risk map to obtain the literature bias risk included in the study as a whole is unclear;the data of relevant outcome indicators were entered in RevMan5.3 software for meta analysis and related inspection analysis.In terms of clinical response rate(RR),Chinese medicine combined with EGFR-TKIs was better than the group of EGFR-TKIs alone.Meta analysis results showed that the differences between the two groups were statistically significant [RR = 1.31,95% CI(1.18,1.44),P <0.00001].In terms of clinical disease control rate(DCR),Chinese medicine combined with EGFR-TKIs was better than that of EGFR-TKIs alone.The meta-analysis showed that the differences between the two groups were statistically significant [RR = 1.16,95% CI(1.11,1.23),P <0.00001].In terms of progression-free survival(PFS),TCM combined with EGFR-TKIs is superior to the EGFR-TKIs group in extending PFS.Meta analysis results showed that the differences between the two groups were statistically significant [MD = 2.92,95% CI(2.82,3.02),P <0.00001].In terms of changes in functional status scores(KPS scores)after treatment,the combination of TCM with EGFR-TKIs was better than that with EGFR-TKIs alone.The meta-analysis results showed that the differences between the two groups were statistically significant [MD = 5.83,95% CI(5.03,6.62),P <0.00001];in terms of the effectiveness of the functional status score(KPS score),the meta-analysis results showed that the two groups The difference was not statistically significant [MD = 1.11,95% CI(0.97,1.28),P = 0.12].In terms of rash incidence,Chinese medicine combined with EGFR-TKIs can reduce the incidence of rash.The meta-analysis results showed that the differences between the two groups were statistically significant [RR = 0.68,95% CI(0.60,0.76),P<0.00001].In terms of the incidence of diarrhea,Chinese medicine combined with EGFR-TKIs can reduce the incidence of diarrhea.The meta-analysis results showed that the differences between the two groups were statistically significant [RR = 0.51,95% CI(0.42,0.62),P <0.00001].In terms of the incidence of liver damage,Chinese medicine combined with EGFR-TKIs can reduce the incidence of liver damage.The meta-analysis showed that the differences between the two groups were statistically significant [RR = 0.57,95% CI(0.39,0.82),P = 0.003].ConclusionCombine meta-analysis results from 21 included articles,it can be proved that TCM combined with EGFR-TKIs is superior to the EGFR-TKIs group in clinical efficacy(RR,DCR),PFS,and KPS,and can reduce rash,diarrhea,and liver damage.Incidence.The quality of the literature included in this study is not high.It is expected that more high-quality randomized controlled studies will be carried out in the future,to verify the efficacy of traditional Chinese medicine combined with targeted treatment of EGFR mutant advanced non-small cell lung cancer.