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. 2021 Jan 29:11:631170.
doi: 10.3389/fphar.2020.631170. eCollection 2020.

Investigation on the Efficiency of Chinese Herbal Injections for Treating Non-small Cell Lung Cancer With Vinorelbine and Cisplatin Based on Multidimensional Bayesian Network Meta-Analysis

Mengwei Ni  1 , Haojia Wang  1 , Miaomiao Wang  1 , Wei Zhou  1 , Jingyuan Zhang  1 , Jiarui Wu  1 , Dan Zhang  1 , Zhiwei Jing  2 , Xinkui Liu  1 , Zhishan Wu  1 , Siyu Guo  1 , Shanshan Jia  1 , Xiaomeng Zhang  1 , Xiaoguang Sheng  1
Affiliations

Investigation on the Efficiency of Chinese Herbal Injections for Treating Non-small Cell Lung Cancer With Vinorelbine and Cisplatin Based on Multidimensional Bayesian Network Meta-Analysis

Mengwei Ni et al. Front Pharmacol. .

Abstract

Background: As non-small cell lung cancer (NSCLC) seriously threatens human health, several clinical studies have reported that Chinese herbal injections (CHIs) combined with vinorelbine and cisplatin (NP) are beneficial. This multidimensional network meta-analysis was performed to explore the preferable options among different CHIs for treating NSCLC. Methods: A literature search was performed in several databases to identify randomized controlled trials (RCTs) of CHIs in the treatment of NSCLC from inception to January 31, 2019. Final included studies met the eligibility criteria and methodological quality recommendations. Data analysis was performed using Stata 13.0 and WinBUGS 14.0 software. Each outcome was presented as an odds ratio and the surface under the cumulative ranking curve value (SCURA). The "scatterplot3d" package in R 3.6.1 software was used to perform multidimensional cluster analysis. Results: Ultimately, 97 eligible RCTs involving 7,440 patients and 14 CHIs were included in this network meta-analysis. Combined with NP chemotherapy, Kanglaite injection plus NP exhibited a better impact on the clinical effectiveness rate (SCURA probability: 78.34%), and Javanica oil emulsion injection plus NP was better in the performance status (95.44%). Huachansu injection plus NP was dominant in reducing thrombocytopenia (92.67%) and gastrointestinal reactions (92.52%). As to multidimensional cluster analysis, Shenmai injection plus NP was superior considering improving the clinical effectiveness rate, performance status and relieving leukopenia. Conclusions: The combination of CHIs and NP has a better impact on patients with NSCLC than NP alone. Among them, Shenmai injection plus NP, Kanglaite injection plus NP and Javanica oil emulsion injection plus NP were notable. Nevertheless, more multicenter and better designed RCTs are needed to validate our findings.

Keywords: Chinese herbal injection; multidimensional cluster analysis; network meta-analysis; non-small cell lung cancer; systematic review; vinorelbine plus cisplatin.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

FIGURE 1
FIGURE 1
Graphical abstract of the network meta-analysis. Note: NP, vinorelbine plus cisplatin; SUCRA, surface under the cumulative ranking curve; OR, odds ratio.
FIGURE 2
FIGURE 2
Flow chart of the search for eligible studies.
FIGURE 3
FIGURE 3
Network graph of outcomes. (A) Clinical effectiveness rate; (B) Performance status; (C) Leukopenia; (D) Hemoglobin reduction; (E) Thrombocytopenia; (F) Gastrointestinal reactions. Note: The width of the lines in the network graph is proportional to the number of RCTs used for the comparisons, and the node sizes correspond to the total sample sizes for the treatments. NP, vinorelbine and cisplatin; ADI, Aidi injection; AI, Astragalus injection; CSI, Chansu injection; CKSI, Compound kushen injection; DLSI, Delisheng injection; HCSI, Huachansu injection; JOEI, Javanica oil emulsion injection; KAI, Kangai injection; KLTI, Kanglaite injection; SFI, Shenfu injection; SMI, Shenmai injection; SQFZI, Shenqifuzheng injection; SGMI, Shengmai injection; XAPI, Xiaoaiping injection.
FIGURE 4
FIGURE 4
Risk of bias graph.
FIGURE 5
FIGURE 5
Plot of the surface under the cumulative ranking curves for outcomes. (A) Clinical effectiveness rate; (B) Performance status; (C) leukopenia; (D) hemoglobin reduction; (E) thrombocytopenia; (F) gastrointestinal reactions. Note: The surface under the cumulative ranking curve (SUCRA) was used to estimate the ranking probabilities for different CHIs, which ranged from 0% to 100%. A better treatment is indicated by a higher SUCRA value. NP, vinorelbine and cisplatin; ADI, Aidi injection; AI, Astragalus injection; CSI, Chansu injection; CKSI, Compound kushen injection; DLSI, Delisheng injection; HCSI, Huachansu injection; JOEI, Javanica oil emulsion injection; KAI, Kangai injection; KLTI, Kanglaite injection; SFI, Shenfu injection; SMI, Shenmai injection; SQFZI, Shenqifuzheng injection; SGMI, Shengmai injection; XAPI, Xiaoaiping injection.
FIGURE 6
FIGURE 6
Plots of the cluster analyses for all types of outcomes. (A) Clinical effectiveness rate (x-axis) and leukopenia (y-axis); (B) Performance status (x-axis) and leukopenia (y-axis); (C) Clinical effectiveness rate (x-axis), performance status (y-axis), and leukopenia (z-axis); (D) Clinical effectiveness rate (x-axis), performance status (y-axis), and hemoglobin (z-axis); (E) Clinical effectiveness rate (x-axis), performance status (y-axis), and thrombocytopenia (z-axis); (F) Clinical effectiveness rate (x-axis), performance status (y-axis), and gastrointestinal reactions (z-axis). Note: Interventions with the same color belong to the same cluster, and interventions located in the upper-right corner indicate optimal therapy for two different outcomes. NP, vinorelbine and cisplatin; ADI, Aidi injection; AI, Astragalus injection; CSI, Chansu injection; CKSI, Compound kushen injection; DLSI, Delisheng injection; HCSI, Huachansu injection; JOEI, Javanica oil emulsion injection; KAI, Kangai injection; KLTI, Kanglaite injection; SFI, Shenfu injection; SMI, Shenmai injection; SQFZI, Shenqifuzheng injection; SGMI, Shengmai injection; XAPI, Xiaoaiping injection.
FIGURE 7
FIGURE 7
Comparison-adjusted funnel plot for outcomes. (A) Clinical effectiveness rate; (B) Performance status. Note: NP, vinorelbine and cisplatin; ADI, Aidi injection; AI, Astragalus injection; CSI, Chansu injection; CKSI, Compound kushen injection; DLSI, Delisheng injection; HCSI, Huachansu injection; JOEI, Javanica oil emulsion injection; KAI, Kangai injection; KLTI, Kanglaite injection; SFI, Shenfu injection; SMI, Shenma injection; SQFZI, Shenqifuzheng injection; SGMI, Shengmai injection; XAPI, Xiaoaiping injection.
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