A systematic review and meta-analysis on the protective effect of combined TCM and western medicine on cardiotoxicity induced by anthracycline chemotherapy

Can Liu, Yan-Wei Xing?, Xin Su, Xu Liu

1. Guang,anmen Hospital, China Academy of Chinese Medical Sciences, Beijing 100053, China

2. Beijing University of Chinese Medicine, Beijing 100029, China

ARTICLE INFO

Article history:Received 12 Feb 2022 Received in revised form 25 Feb 2022 Accepted 2 Mar 2022 Available online 14 Mar 2022

Keywords:TCM Cardio-oncology Cardiotoxicity Meta-analysis Randomized controlled trial

ABSTRACT Objective: To systematically evaluate the therapeutic effect of TCM on cardiotoxicity induced by anthracycline chemotherapy to provide clinical guidance. Methods: China hownet database (CNKI), Chinese biomedical literature retrieval (SinoMed), ten thousand Data knowledge service system (WanFang Data), VIP full-text database (VIP), PubMed,MedLine and the cochrane library were searched from inception to 1st, December,2020.Relevant combined TCM and Western medicine on cardiotoxicity randomized controlled trials (RCTs) were collected. The risk of bias in included RCTs were evaluated according to the Cochrane Handbook. The required indicators were extracted and included in RevMan5.4 analysis. Results: A total of 2844 patients were included in 37 RCTs. The results of metaanalysis showed that compared with the control group, TCM treatment group could alleviate the effect of anthracycline on ventricular ejection function, reduce the effect of anthracycline chemotherapy drugs in lowering left ventricular ejection fraction (WMD=6.44,95%CI 0.38 to 12.50 ,P=0.04), reduce the effect of anthracycline chemotherapy in increasing left ventricular end diastolic diameter (WMD=-0.59,95%CI -0.74 to -0.44 ,P＜0.00001), reduce the effect of anthracycline chemotherapy drugs in increasing left ventricular end systolic diameter (WMD=-0.47,95%CI -0.60 to -0.34 ,P＜0.00001), and reduce the effect of anthracyclines on troponin I (WMD=-0.19,95%CI -0.23 to -0.16 ,P＜0.00001),troponin T (WMD=-0.02,95%CI -0.03 to -0.01 , P＜0.00001) and brain natriuretic peptide (WMD=-32.21,95%CI -58.21 to -6.22,P=0.02). Conclusion: The existing evidence can prove that TCM has a protective effect on cardiotoxicity caused by anthracycline chemotherapy, maintaining left ventricular ejection fraction and ventricular diameter, controlling the level of myocardial injury markers, and alleviating cardiac injury.