Chinese Herbal Medicine and Chemotherapy
in the Treatment of Lung Cancer:
A Meta-Analysis of Randomized Controlled Trials
In medical centers across Asia, patients being treated for lung cancer
frequently use herbal medicine in combination with their chemotherapy.
The Pine Street Foundation is now critically examining published studies
to see whether Chinese herbal medicine, when added to chemotherapy, could
measurably improve treatment outcomes for people with lung cancer, as
compared to using the same chemotherapy alone.
In a meta-analysis of over 100 randomized controlled trials published
in medical journals, Pine Street will analyze all the results from each
trial. We will be looking for the impact of Chinese herbal medicine on
both immediate results (do people using herbal medicine experience less
damage to white blood cells or less drug toxicity?) and long term results
(do people using herbal medicine live longer after treatment and is their
quality of life better?), as compared to treatment with chemotherapy
alone.
We will also be looking carefully at the quality of the published studies,
communicating with study authors to probe beneath the surface of the
reports. Most of the studies we have located in our systematic search
of the medical literature were published in China and one of our goals
with this meta-analysis is to better understand the level of scientific
quality of these studies; many researchers in the Western scientific
community have criticized Chinese studies for their low quality of design
and reporting. By analyzing these studies, we'll determine what study
quality problems are most significant and where improvement is needed.
Pine Street has three primary aims in conducting this meta-analysis.
First, we are using the results of this study as a basis for designing
a double-blinded, randomized trial for patients with lung cancer. Second,
by pointing out where improvements in study methodology are needed, we
hope to contribute to the improvement in quality of clinical studies
in China. Third, we want to educate readers outside of China on the vast
quantity of research being conducted there, research that highlights
the potential clinical benefits of integrative medical care.
We have already completed approximately 30% of this project. We began
with a pilot analysis that looked at a small subset of 24 studies from
among the 1,305 we already identified in our initial search. In the pilot
analysis, we found encouraging preliminary results that suggested not
only were lung cancer patients who added herbal medicine benefiting immediately
in reduced chemotherapy toxicity but also that one and two-year survival
rates may also be higher compared to patients using chemotherapy alone.
What we are learning from these studies seems to confirm what clinicians
at the Pine Street Clinic in San Anselmo, California, have observed in
practice; we will be looking closely at their clinical data by conducting
a rigorous review of the treatment experience of 239 patients with non-small
cell lung cancer treated with an integrative approach at the clinic since
1986.
This review, combined with our meta-analysis, will form the background
for a full-scale, randomized, and controlled double-blinded clinical
trial for patients with non-small cell lung cancer. We are currently
writing a National Institutes of Health (NIH) grant to fund this study,
which would be the first-ever large randomized controlled trial of integrative
medicine and chemotherapy for non-small cell lung cancer conducted at
any American hospital.
This project is at the leading edge of our long-range vision for first
conducting thorough and comprehensive reviews of published trials from
China and then using those results to design "next-generation" clinical
trials. By applying what we have learned from our meta-analyses to the
design of rigorous clinical trials to be conducted in American hospitals,
we hope to contribute useful knowledge that will not only be accepted
by but also of benefit to both medical practitioners and their patients.
Following publication of this meta-analysis of integrative medicine
and lung cancer, we will continue with already planned analyses of the
published medical evidence on bladder, brain, breast, colon, kidney,
liver, pancreatic, and stomach cancers.
Many clinical trials on integrative treatment for patients with these
highly prevalent and deadly cancers have already been published in Asian
languages, but little of this evidence is available to English-language
readers. With these meta-analyses, our goal is to bridge that language
gap and make these data available.
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