Efficacy and safety of traditional Chinese medicine in the treatment of pancreatic cancer

Pancreatic cancer (PC) is a highly malignant solid tumor
.
The main clinical manifestations of PC include digestive symptoms such as anorexia, ascites, and jaundice
.
Distant metastases, including the lungs, bones, and lymph nodes
, may also occur.
Due to its tumor microenvironment and rapid progression, PC has a high mortality rate
.
ESTIMATES OF CANCER EPIDEMIOLOGICAL DATA FROM THE GLOBOCAN DATABASE SUGGEST THAT PANCREATIC TUMORS ACCOUNT FOR 2.
5% OF ALL CANCER CASES, WHILE PANCREATIC TUMORS ACCOUNT FOR 4.
5%
OF ALL CANCER-RELATED DEATHS WORLDWIDE.
These data underscore the need to
improve PC treatment strategies.
The limited efficacy of currently available PC medical treatment is a key cause
of high mortality.
Chemotherapy as a first-line treatment regimen and rare drug therapy with beneficial effects can lead to systemic damage and even fatal side effects
.

With the advancement of TCM research, the clinical value of TCM is increasingly recognized
worldwide.
As a complementary and alternative approach to medicine, TCM has long been used by Chinese patients, especially those with
PC.
In fact, compared to Western medicine, TCM is accepted as a mainstream treatment because of its efficacy and good safety.

Therefore, the wide application of TCM needs to be further explored to reduce the mortality rate
of PC patients.

Flowchart of the selection process:

To date, there is extensive literature on evidence-based research methods in modern medicine related to the use of TCM for the prevention and treatment of PC, including some clinical observational studies and clinical trials
.
Systematic reviews and meta-analyses (SRs/MAs) provide a high level of evidence to guide clinical decision-making and provide an important basis for
clinicians to develop guidelines or conduct relevant research.
Although randomised controlled trials (RCTs) of TCM plus Western medicine for PC pharmacology can be searched in academic databases, the evidence remains incomplete and results remain controversial
.
In addition, a comprehensive review
of SR/MAs evaluating the use of TCM on PCs has not been conducted.
This study aimed to integrate the specific characteristics and outcome indicators of different SRs/MAs, and to evaluate the methodological and quality of evidence of SRs/MAs using AMSTAR2.
0 and GRADE evaluation tools, so as to provide reliable evidence
for the clinical prevention and treatment of PC.

Characteristics of the SRs/MAs：

We systematically searched eight databases for SRs/MAs from randomized controlled trials of TCM treatments for pancreatic cancer (from inception to April 2022).

The methodological quality of SRs/MAs was assessed using AMSTAR 2.
0 and the quality
of the evidence was assessed using GRADE guidelines.
Nine SRs/MAs, including 145 randomised controlled trials
, were considered eligible for this study.
These articles were published between
2014 and 2022.
The sample sizes for randomized controlled trials in MA ranged from 336 to 1,989
.
The methodological quality of these nine studies was very low
.
Of the 59 outcomes of nine SRs/MAs, 7, 33 and 19 had moderate, low, and severely low-quality evidence, respectively, while high-quality evidence was not yet established
.
Results of medium- and long-term indicators, short-term indicators, and adverse reactions of SRs/MAs showed consistency and variability
.

Overall, the methodological and quality of the current evidence is generally low, highlighting the need for further attention to the implementation process
.
Some moderate-quality evidence confirms that several specific TCMs are the best option for
improving short-term clinical outcomes.
However, more objective and high-quality studies are needed to validate the efficacy
of traditional Chinese medicine in the treatment of pancreatic cancer.

Wang J, Wang Q, Zhang P, Zhang R, He J.
Efficacy and safety of traditional Chinese medicine for the treatment of pancreatic cancer: An overview of systematic reviews and meta-analyses.
Front Pharmacol.
2022 Sep 1; 13:896017.
doi: 10.
3389/fphar.
2022.
896017.
PMID: 36120323; PMCID: PMC9475193.