Chinese Medicine Treatment Prolonged Survival in Small Cell Lung Cancer Patients: A Clinical Observation / 中国结合医学杂志

OBJECTIVE@#To evaluate the effect of Chinese medicine (CM) treatment on survival time and quality of life (QOL) in patients with small cell lung cancer (SCLC).@*METHODS@#This was an exploratory and prospective clinical observation. Patients diagnosed with SCLC receiving CM treatment were included and followed up every 3 months. The primary outcome was overall survival (OS), and the secondary outcomes were progression-free survival (PFS) and QOL.@*RESULTS@#A total of 136 patients including 65 limited-stage SCLC (LS-SCLC) patients and 71 extensive-stage SCLC (ES-SCLC) patients were analyzed. The median OS of ES-SCLC patients was 17.27 months, and the median OS of LS-SCLC was 40.07 months. The survival time was 16.27 months for SCLC patients with brain metastasis, 9.83 months for liver metastasis, 13.43 months for bone metastasis, and 18.13 months for lung metastasis. Advanced age, pleural fluid, liver and brain metastasis were risk factors, while longer CM treatment duration was a protective factor. QOL assessment indicated that after 6 months of CM treatment, scores increased in function domains and decreased in symptom domains.@*CONCLUSION@#CM treatment might help prolong OS of SCLC patients. Moreover, CM treatment brought the trend of symptom amelioration and QOL improvement. These results provide preliminary evidence for applying CM in SCLC multi-disciplinary treatment.

Shenyi Capsule () plus Chemotherapy versus Chemotherapy for Non-Small Cell Lung Cancer: A Systematic Review of Overlapping Meta-Analyses / 中国结合医学杂志

<p><b>OBJECTIVE</b>To assist decision-makers interpret and choose among conflfl icting meta-analyses, as well as to offer treatment recommendations based on current best evidence by performing a systematic review of overlapping meta-analyses regarding Shenyi Capsule (, SC) plus chemotherapy versus chemotherapy of non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>A literature search was conducted to select systematic reviews comparing SC plus chemotherapy with chemotherapy for NSCLC. Meta-analyses only composed of randomized controlled trials (RCTs) met the inclusion criteria. Two authors individually estimated the quality of meta-analysis and extracted data. The Jadad decision algorithm was applied to guarantee which meta-analysis provided the best original evidence.</p><p><b>RESULTS</b>A total of 5 meta-analyses were included. All the studies composed of RCTs or quasi-RCTs and were regarded as level-II evidence. The scores of the Assessment of Multiple Systematic Reviews ranged from 3 to 6 (median 4). A high-quality meta-analysis with more RCTs was chosen, which suggested that SC plus chemotherapy could increase incidence of short-term efficacy, improve the quality of life and survival rate in comparison to chemotherapy. However, there was no statistically significant difference between SC plus chemotherapy and chemotherapy regarding chemotherapy-induced side effect, such as liver and kidney function obstacle, leukopenia, hemoglobin decrement and gastrointestinal adverse reaction.</p><p><b>CONCLUSIONS</b>Based on the best available evidence, treatment effect of SC plus chemotherapy was better than chemotherapy and did not increase side effects. Therefore, SC plus chemotherapy may be superior to chemotherapy for treating NSCLC. However, due to some limitations, SC plus chemotherapy should be cautiously considered, and further high-quality meta-analyses are needed.</p>

Different Survival Benefits of Chinese Medicine for Pancreatic Cancer: How to Choose? / 中国结合医学杂志

<p><b>OBJECTIVE</b>To assess the efficacy of Chinese medicine (CM) on patients with pancreatic cancer (PC) in a retrospective population-based study.</p><p><b>METHODS</b>Between January 1, 2013, and August 30, 2016, according to whether received Western medicine treatment, the patients were included into either integrative medicine (IM) group or CM group. All enrolled patients were orally administrated with Gexia Zhuyu Decoction () or Liujun Ermu Decoction () by syndrome differentiation, twice a day, last for at least 2 months. The primary end point was overall survival (OS).</p><p><b>RESULTS</b>A total of 174 patients with PC were enrolled in this study. In stage I/II, the median OS was 20.5 months in the IM group [95% confidence interval (CI), 12.499 to 28.501] and 11.17 months in the CM group (95% CI, 5.160 to 17.180, P=0.015). The 1- and 2-year survival rates for the two groups were 47.0%, 40.0% and 21.0%, 21.0%, respectively. In stage III/IV, median OS was 13.53 months (95% CI, 8.665 to 18.395) in the IM group versus 6.4 months (95% CI, 0.00 to 15.682) in the CM group, respectively (P=0.32). The 1- and 2-year survival rate for the IM and CM groups were 27.0%, 7.0% and 20.0%, 2.0%, respectively.</p><p><b>CONCLUSIONS</b>Intervention of CM contributes to the different survival benefits for PC in different stages. Multimodality treatment might be a promising strategy for PC patients in early stage. While, in advanced stage, CM might be an alternative candidate for PC patients.</p>

Comprehensive treatment with Chinese medicine in patients with advanced non-small cell lung cancer: A multicenter, prospective, cohort study / 中国结合医学杂志

<p><b>OBJECTIVE</b>To determine whether additional Chinese medicine (CM) could prolong survival and improve the quality of life (QOL) in patients with advanced non-small cell lung cancer (NSCLC) compared with Western medicine (WM) alone.</p><p><b>METHODS</b>This was a multicenter, prospective cohort study. A total of 474 hospitalized patients with stage III-IV NSCLC were recruited and divided into 2 groups. Patients in the WM group received radiotherapy, chemotherapy, and optimal supportive therapy according to the National Comprehensive Cancer Network (NCCN) guidelines. In the integrative medicine (IM) group, individualized CM (Chinese patent medicines and injections) and WM were administered. The primary end point was overall survival, and the secondary end points were time to disease progression, adverse events, and QOL. Follow-up clinical examinations and chest radiography were performed every 2 months.</p><p><b>RESULTS</b>The median survival was 16.60 months in the IM group and 13.13 months in the WM group (P<0.01). The incidences of loss of appetite, nausea, and vomiting in the IM group were significantly lower than those in the WM group (P<0.05). The QOL based on Functional Assessment of Cancer Therapy-Lung in the IM group was markedly higher than that in the WM group at the fourth course (P<0.05).</p><p><b>CONCLUSIONS</b>Additional CM may prolong survival and improve the QOL patients with NSCLC. The adverse effects of radio- and chemotherapy may be attenuated as CM is used in combination with conventional treatments.</p>

Effect of Lignum sappan containing serum on the proliferation cycle of human lung cancer cell line PG: a comparative study / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the effect of Lignum Sappan (LS) containing serum on the proliferation cycle arrest of human lung cancer cell line PG and its molecular mechanism.</p><p><b>METHODS</b>The lung cancer PG cells were divided into four groups, i.e., the blank control group, the LS group, the LS plus cisplatin group, and the cisplatin group. They were cultured by RPMI-1640 with 20% blank serum, RPMI-1640 with 20% LS containing serum, RPMI-1640 with 20% LS containing serum plus 1 microg/mL cisplatin, and RPMI-1640 with 20% blank serum plus 1 microg/mL cisplatin, respectively. The morphology of PG cells was observed using light microscope and laser scanning confocal microscope in each group. The cell cycle arrest was observed using flow cytometry. The expression of P16 and Rb1 mRNA was tested by PCR method.</p><p><b>RESULTS</b>Under the light microscope and laser scanning confocal microscope, the apoptosis degree of PG cells in the LS group was significant, but less than that of the LS plus cisplatin group as well as the cisplatin group. Compared with the blank control group, the proportion of PG cells increased at G0/ G1 and S phases (P < 0.05) and decreased at G2/M phase (P < 0.01) in the LS group; The proportion of PG cells increased at G2/M and S phases (P < 0.05, P < 0.01) and decreased at G0/G1 phase (P < 0.01) in the LS plus cisplatin group as well as the cisplatin group. Compared with the LS group, the proportion of PG cells increased at G2/M and S phases (P < 0.05, P < 0.01) and decreased at G0/G1 phase (P < 0.01) in the LS plus cisplatin group as well as the cisplatin group. There was no statistical difference in PG cells at each phase between the cisplatin group and the LS plus cisplatin group (P > 0.05). The expression of P16 and Rb1 mRNA increased in the LS group, when compared with the blank control group. They also increased in the cisplatin group and the LS plus cisplatin group, higher than that of the LS group (P < 0.05). There was no statistical difference in the expression of P16 and Rb1 mRNA between the cisplatin group and the LS plus cisplatin group (P > 0.05).</p><p><b>CONCLUSION</b>LS containing serum induced PG cell apoptosis by up-regulating the mRNA transcription levels of P16 and Rb1, thus resulting in PG cell arrest at G0/G1 and S phases, which was different from the manner of cisplatin (achieved by arresting PG cells at G2/M and S phases through regulating cyclinB1 mRNA transcription).</p>

Study on qi deficiency syndrome distribution and quality of life in patients with advanced non-small cell lung cancer / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To study the qi deficiency syndrome distribution and quality of life (QOL) of patients with advanced non-small cell lung cancer (NSCLC).</p><p><b>METHODS</b>A questionnaire survey was conducted in 120 patients with advanced NSCLC using the QOL scale "Functional Assessment of Cancer Therapy" (FACT-L) (Version 4.0). Meanwhile, syndrome typing was performed. On the basis of results of syndrome typing, patients of different syndrome types were grouped and compared, thus studying the distribution of advanced NSCLC patients of qi deficiency syndrome and qi deficiency syndrome correlated QOL features.</p><p><b>RESULTS</b>Qi deficiency, blood stasis, yin deficiency, phlegm and dampness dominated in syndrome types of the 120 patients with advanced NSCLC. Of syndrome types accounting for larger ratios in 112 patients, pure qi deficiency syndrome accounted for 30.36% (34 cases), qi deficiency and blood stasis syndrome for 18. 75% (21 cases), both qi and yin deficiency syndrome for 10. 71% (12 cases). There was no correlation between the appearance of qi deficiency syndrome and patients' age, sex, pathological typing (adenocarcinoma/squamous carcinoma), or the disease duration. NSCLC patients in phase IV were mostly complicated with qi deficiency syndrome (P<0.05). Scores of physical states, emotional states, functional states, and total scores in the FACT-L scale were lower in those complicated with qi deficiency syndrome (89 cases) than in those without complicated qi deficiency syndrome (31 cases), showing statistical difference (P<0.01, P<0.05). The scores of the lung cancer specific module (additional concerns) in the FACT-L scale showed statistical difference, sequenced as qi deficiency and blood stasis syndrome > pure qi deficiency syndrome > both qi and yin deficiency syndrome (P<0.05).</p><p><b>CONCLUSIONS</b>Qi deficiency syndrome is the main syndrome of advanced NSCLC. The QOL of advanced NSCLC patients complicated with qi deficiency syndrome was poorer than those without complicated qi deficiency syndrome. Besides, along with the aggravation of qi deficiency syndrome, the QOL decreased somewhat. It suggested that symptomatic treatment of qi deficiency syndrome could improve advanced NSCLC patients' QOL.</p>

Comparative study on the methods of Chinese medicine and Western medicine therapeutic evaluation for advanced non-small cell lung cancer / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To compare the differences and characteristics in Chinese medicine (CM) and Western medicine therapeutic evaluation methods in the application of advanced non-small cell lung cancer.</p><p><b>METHODS</b>A total of 200 cases of advanced non-small cell lung cancer from 3 subcenters were enrolled the study and assigned to two groups, 104 in the CM group treated with CM injection combined with treatment based on syndrome differentiation, 96 in the chemotherapy group treated with the international chemothearapy scheme, both the course of treatment was 6 weeks. Their short-term therapeutic effects were observed by the "clinic efficacy appraisal standard of therapy for advanced lung cancer with CM" simultaneously and by the follow-up Western medical solid tumor's effect evaluation criterion, including clinical symptoms, tumor body, Karnorfsky score, body weight and immune function evaluation.</p><p><b>RESULTS</b>According to WHO solid tumor's effect evaluation criterion, the efficacy of the chemotherapy group was much better than that of the CM group (P < 0.01). While, according to the "clinic efficacy appraisal standard of therapy for advanced lung cancer with CM", the efficacy of the CM group was better than that of the chemotherapy group without statistical difference (P = 0.05), however, there was a very strong trend of appearing difference. There was difference inult o the results of the two evaluation methods.</p><p><b>CONCLUSION</b>Compared with WHO solid tumor's effect evaluation criterion, "the clinic efficacy appraisal standard of therapy for advanced lung cancer with CM" can reflect more features and advantages of CM for cancer treatment, having value for further study.</p>

Effects of Lignum Sappen on growth and metastases of Lewis lung carcinoma at different phases in C57BL/6 mice / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effects of Lignum Sappan (LS) on the growth and metastases of transplanted Lewis lung carcinoma (LLC) in mice and investigate its partial mechanism of action.</p><p><b>METHODS</b>C57BL/6 mice were established in LLC model and divided into six groups in random: Group A was untreated; Group B was treated by chemotherapy (CM) only; Groups C-F were treated respectively with low-dose LS, high-dose LS, CM + low-dose LS and CM + high-dose LS, via intragastric administration for 21 successive days. Mice were sacrificed in batches at different time points (d 7, d 14 and d 21) to observe the tumor inhibition rate and the metastases suppressing rate was measured dynamically. Meantime, the CD44 expression in tumor cells was measured by flow cytometry and serum P-selectin concentration was measured by ELISA assay.</p><p><b>RESULTS</b>Tumor weight in all treated groups, except Group C, was lower than that in Group A at the three time points (P < 0.05, P < 0.01), and that was lower in Group F than in Group B at the corresponding time points (P < 0.05, P < 0.01). Comparisons of CD44+ in tumor cells showed that as compared with Group A, on d 7, it was lower in Groups B and D (P < 0.01); on d 14, it was lower in Group E (P < 0.01) and Group F (P < 0.05); and on d 21, it was lower in Groups E and F (P < 0.01). As for the concentration of P-selectin, the intergroup comparisons showed that it was lower in Groups B-F on d 7 and in Group F on d 21 than that in Group A (P < 0.05 or P < 0.01), but showed insignificant difference in comparing the Group A with all the treated Groups on d 14 (P > 0.05).</p><p><b>CONCLUSION</b>LS and CM +LS could inhibit the growth and metastases of LLC, and shows inhibition on CD44 expression in tumor cells and P-selectin level in serum, which may be one of the mechanisms of LS in suppressing tumor metastasis.</p>

Apoptotic protease activating factor 1 inducing apoptosis and related anti-tumor therapy -- review / 中国实验血液学杂志

Apoptotic protease activating factor-1 (Apaf1) is an essential factor in intrinsic mitochondrial pathway of apoptosis activation. Apaf1 leads to the formation of apoptosome, which then proteolytically activates caspase-9. The activated caspase-9 opens the downstream signal of caspases to execute programmed cell death. Apaf-1 is important for tumor suppression and drug resistance because it plays a central role in DNA damage-induced apoptosis. Inactivation of the Apaf-1 gene is implicated in disease progression and chemoresistance of some malignancies. Further research on the Apaf-1 will contribute to develop a new type of approach to anti-cancer drugs, which might have good prospect in clinical practice. In this paper, the structure and function of Apaf-1, the mechanism involved in Apaf-1 signaling pathway, and application of Apaf-1 in tumor therapy were reviewed.