Synergistic Anti-cancer Effect and Mechanism of FZKA Decoction Combined with Gefitinib on A549 Cells / 中国实验方剂学杂志

Objective::To observe the effect of Fuzheng Kangai (FZKA) decoction combined with gefitinib on the cells proliferation, apoptosis, invasion and metastasis of human lung adenocarcinoma A549 cells in vitro and in vivo, and relevant mechanisms. Method::The A549 cell proliferation of the control group, FZKA decoction groups (0.2, 0.4, 0.8, 1.6, 3.2 g·L-1), Gefitinib groups (10, 20, 40, 60, 80, 100 μmol·L-1) for 24, 48, 72 hours, and FZKA decoction (2 g·L-1) combined with Gefitinib (10 μmol·L-1) groups for 24 hours was detected by methylthiazolyldiphenyl-tetrazolium bromide (MTT) assay. The changes of cell apoptosis, invasion and metastasis abilities of A549 cells were analyzed by flow cytometry, Wound Healing, transwell invasion assay. Western blot assay was used to examine the protein expressions of cleaved Caspase-3, B-cell lymphoma-2 (Bcl-2), B-cell lymphoma-2 associated X (Bax), F-box and WD repeat domain-containing (FBW7) and myeloid cell leukemia-1 (MCL-1) in vitro. Result::Compared with control group, FZKA decoction group and Gefitinib group inhibited the cell proliferation, cell apoptosis, cell invasion and metastasis abilities in a dose-dependent and time-dependent manner, and improve the protein expressions of Bax, Caspase-3, FBW7, but decreased the protein expressions of Bcl-2, MCL-1 (P<0.05). Compared with treatment with Gefitinib alone, FZKA combined with Gefitinib inhibited the proliferation of A549 cells, and induced apoptosis more significantly (P<0.05). Compared with treatment with Gefitinib alone, the cell scratch healing and invasion abilities were significantly reduced after combined treatment (P<0.05). FZKA decoction combined with Gefitinib up-regulated Bax, Caspase-3 and FBW7 protein expressions, and down-regulated Bcl-2 and MCL-1 protein expressions compared with treatment with Gifitinib alone (P<0.05). Conclusion::FZKA decoction combined with Gefitinib can inhibit the proliferation, invasion and metastasis, and induce apoptosis on A549 cells. The mechanism may be associated with the FBW7/MCL-1 pathway.

Mechanism of Modified Maimendong Tang Combined with Cisplatin in Enhancing Chemosensitivity on Human Lung Adenocarcinoma A549 Cells / 中国实验方剂学杂志

Objective: To observe effect of modified Maimendong Tang combined with cisplatin on the cell proliferation, apoptosis, invasion and metastasis and the protein expressions of Caspase-3, epidermal growth factor receptor(EGFR)of human lung adenocarcinoma A549 cells in vitro, so as to investigate their relevant mechanisms in inhibiting cells proliferation, invasion and metastasis and inducing apoptosis of A549 cells. Method: The lung cancer cells A549 were respectively treated with modified Maimendong Tang(15 g·L-1), cisplatin(9 mg·L-1), and combined drugs. Afterwards, they were divided into control group, modified Maimendong Tang group, cisplatin group and modified Maimendong Tang combined with cisplatin group. Thiazolyl blue tetrazolium bromide (MTT) assay was used to evaluate the proliferation of A549 cells treated with different concentrations of modified Maimendong Tang(0, 5, 10, 15, 20, 25 g·L-1) and cisplatin(0, 3, 6, 9, 12, 15 mg·L-1) for 24, 48, 72 h. The proliferation of A549 cells in each group was detected by MTT assay; flow cytometry was used to detect the degree of apoptosis and cycle in the above four groups of cells; scratch test and transwell migration test were performed to observe the abilities of invasion and metastasis of each group; Western blot was used to detect Caspase-3 and EGFR protein expression. Result: The concentration of modified Maimendong Tang and cisplatin and the time of intervention were negatively correlated with the proliferative capacity of A549 cells (PP0/G1 phase increased apparently, and the cells in S phase decreased significantly (PPConclusion: Modified Maimendong Tang combined with cisplatin can inhibit the proliferation, invasion and metastasis and induce the apoptosis of lung cancer cells. Modified Maimendong Tang can synergistically enhance the action of cisplatin. The mechanism may be related to the down-regulation of Caspase-3 and EGFR protein expressions.

Gefitinib plus Fuzheng Kang'ai Formula () in Patients with Advanced Non-Small Cell Lung Cancer with Epidermal Growth Factor Receptor Mutation: A Randomized Controlled Trial / 中国结合医学杂志

<p><b>OBJECTIVE</b>To evaluate the effect of Fuzheng Kang'ai Formula (, FZKA) plus gefitinib in patients with advanced non-small cell lung cancer with epidermal growth factor receptor (EGFR) mutations.</p><p><b>METHODS</b>A randomized controlled trial was conducted from 2009 to 2012 in South China. Seventy chemotherapynaive patients diagnosed with stage IIIB/IV non-small cell lung cancer with EGFR mutations were randomly assigned to GF group [gefitinib (250 mg/day orally) plus FZKA (250 mL, twice per day, orally); 35 cases] or G group (gefitinib 250 mg/day orally; 35 cases) according to the random number table and received treatment until progression of the disease, or development of unacceptable toxicities. The primary endpoint [progression-free survival (PFS)] and secondary endpoints [median survival time (MST), objective response rate (ORR), disease control rate (DCR) and safety] were observed.</p><p><b>RESULTS</b>No patient was excluded after randomization. GF group had significantly longer PFS and MST compared with the G group, with median PFS of 12.5 months (95% CI 3.30-21.69) vs. 8.4 months (95% CI 6.30-10.50; log-rank P<0.01), MST of 21.5 months (95% CI 17.28-25.73) vs. 18.3 months (95% CI 17.97-18.63; log-rank P<0.01). ORR and DCR in GF group and G group were 65.7% vs. 57.1%, 94.3% vs. 80.0%, respectively (P>0.05). The most common toxic effects in the GF group and G group were rash or acne (42.8% vs. 57.1%, P>0.05), diarrhea (11.5% vs. 31.4%, P<0.05), and stomatitis (2.9% vs. 8.7%, P>0.05).</p><p><b>CONCLUSION</b>Patients with advanced non-small cell lung cancer selected by EGFR mutations have longer PFS, MST with less toxicity treated with gefitinib plus FZKA than gefitinib alone.</p>

Combination of Jianpi Liqi Yiliu Formula with Cytokine-induced Killer Cell Treatment for Advanced Hepatocellular Carcinoma / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To evaluate the clinical efficacy of Jianpi Liqi Yiliu Formula (JLYF) combined with cytokine-induced killer (CIK) cells for treating patients with advanced hepatocellular carcinoma (HCC).</p><p><b>METHODS</b>Between January 2011 and January 2014, 60 advanced HCC patients were enrolled in this study, who were assigned to the treatment group and the control group according to their willingness for taking JLYF, 30 cases in each group. All patients received CIK cell treatment: 1 x 10⁹-3 x 10⁹ each time, by intravenous dripping from the 1st day to the 3rd day, once per day. Besides, patients in the treatment group took JLYF decoction, while those in the control group took Chinese medical decoction by syndrome typing. All patients received treatment of at least two cycles. The time to progression (TTP) , overall survival (OS), disease control rate (DCR), performance status scale (PS), Child-Pugh scale, and adverse reactions were observed, and subgroup analyzed.</p><p><b>RESULTS</b>To May 31, 2014, all patients reached the clinical endpoint. TTP was 3.5 months (95% Cl: 3.30-4.10) in the treatment group, better than that (2.5 months, 95% CI: 2.32-2.68) of the control group (P < 0.05). DCR was 36.7% in the treatment group and 30.0% in the control group (P > 0.05). OS was 5.2 months (95% CI: 4.53-5.87) in the treatment group and 4.6 months (95% CI: 4.06-5.14) in the control group (P > 0.05). The PS scale was 1.60 ± 0.10 after treatment, lower than that (1.80 ± 0.09) before treatment in the treatment group (P < 0.05). When the PS scale was 0-2 or Child-Pugh scale was class A, TTP was longer in the treatment group than in the control group (P < 0.05). No adverse reaction occurred in the two groups during the treatment course.</p><p><b>CONCLUSIONS</b>The combination of JLYF with ClK cell treatment could prolong advanced HCC patients' TTP, improve PS scale, as compared with syndrome typed Chinese medical decoction treatment group. Besides, when the PS scale was 0-2 or Child-Pugh scale was class A, it was a better treatment program for advanced HCC patients.</p>

Treating primary liver cancer patients by Pi-strengthening and Qi-regulating method: univariate and multivariate analyses of their prognoses / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To evaluate the prognostic factors in treating primary liver cancer (PLC) patients by Pi-strengthening and qi-regulating method (PSQRM), thus providing evidence and optimizing Pi-strengthening and qi-regulating program.</p><p><b>METHODS</b>Clinical data of 151 PLC patients treated by PSQRM at Oncology Department, Guangdong Provincial Hospital of Traditional Chinese Medicine from May 2007 to March 2009 were retrospectively analyzed. The univariate analysis was determined to analyze possible prognostic factors. Selected key factors were introduced into the COX proportional hazard model, and multivariate analysis was carried out.</p><p><b>RESULTS</b>The 1-year survival rate was 21.85%, the median survival time was 6.80 months, and the mean survival time was 8.98 months. The univariate analysis showed that Chinese medicine (CM) syndrome types, clinical symptoms at the initial diagnosis, ascites, tumor types, ratios of foci, portal vein tumor thrombus, intrahepatic metastasis, a-fetoprotein (AFP) levels, total bilirubin classification, albumin classification, Child-Pugh classification, and domestic staging of liver cancer were significant prognostic factors (P < 0.05). The statistic data of multivariate analysis indicated that CM syndrome types, ascites, tumor types, portal vein tumor thrombus, AFP levels, Child-Pugh classification, and domestic staging of liver cancer were independent factors influencing prognosis (P < 0.05).</p><p><b>CONCLUSION</b>The prognosis of PLC treated with PSQRM is determined by multiple factors including CM syndrome types, ascites, tumor types, portal vein tumor thrombus, AFP levels, Child-Pugh classification, and domestic staging of liver cancer.</p>

Xiaoji Decoction inhibited cell proliferation and induced apoptosis through Akt signaling pathway in human lung cancer A549 cells / 中国结合医学杂志

<p><b>OBJECTIVE</b>To investigate the inhibitive effect and the underlying mechanism of Xiaoji Decoction (, XJD) in human lung cancer A549 cells.</p><p><b>METHODS</b>A549 cells in logarithmic proliferation were cultivated in RPMI-1640 containing 10% low, medium or high dosages of XJD serum. The inhibitive effect of XJD in A549 cell proliferation was assessed by methylthiazolyldiphenyl-tetrazolium bromide (MTT) assay. The pro-apoptotic effect of XJD in A549 cells was observed by fluorescence microscope via Hoechst 33258 staining. The role of the Akt signaling pathway was observed by examining the presence of p-Akt protein by Western blot and the mRNA expression of downstream proteins such as Bcl-2/Bcl-XL-associated death promoter (BAD) and caspase-9 by real time polymerase chain reaction.</p><p><b>RESULTS</b>MTT assay revealed that XJD could inhibit A549 proliferation in a dose- and time-dependent manner. Hoechst 33258 staining showed that XJD induced the typical nuclear apoptotic morphology after XJD treatment. Moreover, XJD could reduce the phosphorylation of Akt and increase the mRNA expression of BAD and caspase-9.</p><p><b>CONCLUSIONS</b>XJD can inhibit the proliferation of A549 cells in a dose- and time-dependent manner through signaling Akt pathway via up-regulating the expression of BAD and caspase-9. XJD may provide a novel therapeutic model for lung cancer and deserve further study.</p>

The distribution of Chinese medicine syndrome types in primary liver cancer and their differences of the survival time: a clinical study / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To explore the distribution of Chinese medicine (CM) syndrome types in primary liver cancer (PLC) and their differences of the survival time.</p><p><b>METHODS</b>From May 2007 to March 2009, recruited were 151 PLC inpatients at Department of Tumor, Guangdong Provincial Hospital of Traditional Chinese Medicine. Their survival time were statistically calculated. Patients' average survival time and median survival time were calculated using Kaplan-Meier method. The Log-rank test was used to analyze their differences of survival time among different CM syndrome types.</p><p><b>RESULTS</b>The proportion of CM syndrome types in PLC patients were ranked from high to low as follows: mutual accumulation of dampness and blood stasis syndrome [MADBSS, 43.0% (65/151)], Gan-stagnation Pi-deficiency syndrome [GSPDS, 34.4% (52/151)], qi stagnation blood stasis syndrome [QSBSS, 9.3% (14/151)], retention of damp-heat syndrome [RDHS, 8.6%(13/151)], and Gan-Shen yin deficiency syndrome [GSYDS, 4.6% (7/ 151)]. The median survival time of different CM syndrome types were ranked from longer to shorter as follows: GSPDS (14.77 months), QSBSS (6.13 months), RDHS (5.27 months), MADBSS (4.78 months), and GSYDS (0.80 months). The mean survival times were ranked from longer to shorter as follows: GSPDS (12.40 months), QSBSS (8.84 months), MADBSS (6.99 months), RDHS (7.08 months), and GSYDS (0.72 months). There was statistical difference in the difference of the survival time among different CM syndrome types (P < 0.05).</p><p><b>CONCLUSIONS</b>GSPDS and MADBSS were the most common CM syndrome types in PLC patients. There was difference in the survival time between GSPDS and MADBSS/between RDHS and GSYDS. There was difference in the survival time between MADBSS and GSYDS. Patients of GSPDS might get the best prognosis, while patients of GSYDS might get the poorest prognosis.</p>

Influence of Shenfu Injection on the quality of life of lung cancer patients receiving chemotherapy / 南方医科大学学报

<p><b>OBJECTIVE</b>To evaluate the influence of Shenfu Injection (SHF) on the quality of life of patients with advanced non-small cell lung cancer (NSCLC) receiving chemotherapy.</p><p><b>METHODS</b>A total of 133 patients with NSCLC receiving at least two cycles of chemotherapy with taxol plus cisplatin (TP)/vinorelbine plus cisplatin (NP) or gemcitabine plus cisplatin (GP) were randomized into SHF pre-treatment group (with SHF given only in the first cycle) and SHF post-treatment group (with SHF given only in the second cycle). The Quality of Life Questionnaire-Core 30 (QLQ-C30) and the Functional Living Index-Cancer (FLIC) were used to evaluate the quality of life of the patients after the treatments.</p><p><b>RESULTS</b>Both of the groups showed improved quality of life after the treatments (P<0.01), but the improvements were more obvious in SHF pre-treatment group (P<0.05). SHF showed favorable effects in relieving such adverse effects as fatigue, nausea, vomiting and diarrhea associated with the chemotherapy.</p><p><b>CONCLUSION</b>SHF can improve the quality of life in NSCLC patients receiving chemotherapies.</p>

Alternative and complementary effect of Chinese medicine in treating malignant tumor / 中国中西医结合杂志

In this article, the concept of complementary and alternative medicine (CAM) was reviewed, and the functions and status of Chinese medicine in malignant tumor therapy as a CAM were summarized. The major usage of Chinese medicine as a CAM in treatment of malignant tumor are as follows: (1) Chinese medicine alone can be used as an alternative therapy for advanced patients who cannot benefit from chemotherapy or radiotherapy; (2) Chinese medicine can be used together with chemotherapy or radiotherapy as a complementary therapy to alleviate signs and symptoms, reduce toxicities and increase effect; (3) Chinese medicine can be used as an alternative therapy for elderly or patients with poor performance status (PS); (4) it can also combine with new technology (e.g., extracorporeal high frequency thermotherapy, radioactive seed implantation, and radiofrequency ablation) as a complementary treatment; (5) Chinese medicine can work with molecular target therapeutic drugs to increase efficacy and sensitivity, reduce toxicities, improve quality of life and prolong survival; (6) Chinese medicine can act as a maintenance therapy after surgery, chemotherapy and radiotherapy; (7) Chinese medicine can also be taken as a preventive measure in high-risk patients with pre-cancerous diseases or "tumor-free" status. Finally, the author concluded the prescription pattern of Chinese medicine in treatment of malignant tumor, and presented several clinical effective cases treated with Chinese medicine.

Treatment of advanced non-small cell lung cancer with extracorporeal high frequency thermotherapy combined with Chinese medicine / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the clinical efficacy and benefit response of extracorporeal high frequency thermotherapy (EHFT) combined with Chinese medicine (CM) in the treatment of patients with advanced nonsmall cell lung cancer.</p><p><b>METHODS</b>The study adopted a prospective, small sample and randomized controlled method, and the advanced non-small cell lung cancer patients were assigned to two groups according to the table of random digits, one having the treatment of EHFT combined with CM (the treatment group), the other only with CM (the control group). The patients in the treatment group were treated with EHFT one hour once per day, together with CM differentiation decoction, 250 mL orally taken, twice daily for 14 days as one cycle, and 3-4 cycles was performed. The patients in the control group were treated only with CM differentiation decoction using the same dose as the treatment group. The efficacies were evaluated after three to four cycles of treatment. Primary endpoints were disease control rate (DCR) and time to progression (TTP). Secondary endpoints were overall survival time and 1-year survival rate.</p><p><b>RESULTS</b>Sixty-six patients accomplished the study. After the patients underwent different treatments, none of the patients got a complete response or partial response in both groups. In the treatment group, DCR was 72.2%, and 10 had progression of disease (28.8%), while the DCR of the control group was 63.3%, and 11 had progression of disease (36.7%); there was a significant statistical difference (P <0.05), suggesting that the combined regimen had superiority on the DCR. As for long-term efficacy, the median survival time (MST) of the treatment group was 7.5 months, TTP was 5.5 months, and 1-year survival rate was 21.4 %; in the control group, the results were 6.8 months, 4.5 months and 16.6% respectively. There was significant statistical difference on TTP (P <0.05), but no difference on MST or 1-year survival rate.</p><p><b>CONCLUSION</b>EHFT combined with CM differentiation has better tolerance and short-term efficacy in the treatment of patients with advanced NSCLC.</p>

Effect of shenfu injection for attenuating the toxicity of cisplatin-based regimens in treating non-small cell lung cancer / 中国中西医结合杂志

<p><b>OBJECTIVE</b>To observe the effect of Shenfu Injection (SFI) for attenuating the toxicity of chemotherapy in treating non-small-cell lung cancer (NSCLC), by the regimens of combined Cisplatin (DDP) with new chemotherapeutic agents, Taxol (TXT), Vinorelbine (NVB) and Gemcitabine (GEM), respectively.</p><p><b>METHODS</b>One hundred and thirty-three patients with NSCLC, who were scheduled to be treated by at least 2 cycles of chemotherapy, with regimen TP (45 cases), NP (42 cases) and GP (46 cases), were enrolled. They were randomized into 2 groups: 67 cases in the SFI pre-treated group and 66 cases in the SFI post-treated group, on them SFI was administered for 10 successive days on the 1st, 2nd, 3rd day of the 1st and the 2nd cycle, respectively. The effects of SFI on toxicity of the three regimens were observed through a self-controlled crossover design.</p><p><b>RESULTS</b>The hemato-toxicity (the toxicity on leukocyte, neutrophil, hemoglobin and platelet) and the digestive toxicity (represented as vomiting, constipation or diarrhea) of chemotherapy revealed in the treated stage (the cycle treated with SFI) were all less than those in the control stage (the cycle untreated with SFI), no matter when SFI was applied, all showed statistical significance (P < 0.05 or P < 0.01). Besides, SFI showed a better toxicity attenuating effect on patients of qi-deficiency and phlegm-dampness type (P < 0.01).</p><p><b>CONCLUSION</b>SFI can relieve the hemato-toxicity and the digestive toxicity of chemotherapy by regimen of combining DDP with TXT, NVB or GEM, and the effect is more significant on patients of qi-deficiency and phlegm-dampness type.</p>

Improvement of quality of life with Shenfu injection in non small cell lung cancer patients treated with gemcitabine plus cisplatin regimen / 中国结合医学杂志

<p><b>OBJECTIVE</b>To observe the effect of Shenfu injection (SFI) in treating non small cell lung cancer (NSCLC) patients on quality of life with gemcitabine (GEM) plus cisplatin (GP) regimen.</p><p><b>METHODS</b>Thirty-four patients were ready to receive GP regimen chemotherapy for treating NSCLC disease, according to lot-drawing, they were divided into SFI pre-treatment group (18 cases) and SFI post-treatment group (16 cases). SFI pre-treatment group: During the first treatment course, chemotherapy was begun with SFI 60 ml, intravenous dripping on the 3rd day, once daily, consecutively for 10 days; on the 1st day, GP regimen (GEM 1250 mg/m(2), intravenous dripping, on the 1st and 8th day; cisplatin 70 mg/m(2) on the 2nd day; 21 days as one cycle) was carried out; in the second treatment course GP regimen was merely given to serve as the self-control. SFI post-treatment group: the medicament sequence order was reversed from that of pre-treatment group. Using dual international quality of life (QOL) scores, the effect of SFI on the patients' QOL was observed through randomized self pre- and post-crossover control.</p><p><b>RESULTS</b>The QOL in the 34 patients after being treated by SFI in combination with GP chemotherapy regimen in one group, and GP chemotherapy regimen alone in the other, was improved in different degrees, with significant difference (P < 0.01); comparison of SFI combined with GP chemotherapy regimen with GP chemotherapy alone showed that QOL in patients was significantly different (P < 0.01).</p><p><b>CONCLUSION</b>SFI could improve QOL in patients with NSCLC who were treated with GP regimen.</p>