A combined analysis of 34 studies, performed by researchers at the University of California at Berkeley, suggests that Astragalus-based Chinese herbal medicine may increase the effectiveness of platinum-based chemotherapy regimens for advanced non-small cell lung cancer (NSCLC). However, they also concluded that these observations would have to be confirmed in controlled randomized trials. The details of this analysis was published in the January 20, 2006, issue of the Journal of Clinical Oncology.

In China, the herb Astragalus membranaceus is frequently combined with chemotherapy in the treatment of lung cancer to reduce toxicity and improve efficacy. Astragalus may work by stimulating macrophage and natural killer cell activity.

To summarize what is known about the combination of Astragalus-based Chinese medicine and standard platinum-based chemotherapy for NSCLC, researchers combined information from 34 published clinical trials. These trials enrolled a total of 2815 patients. These researchers assessed whether Astragalus-based herbal medicine increased the effectiveness and decreased the toxicity of standard platinum-based chemotherapy.

At 12 months, risk of death was reduced by 33% among patients treated with Astragalus-based herbal medicine and chemotherapy, compared to patients treated with chemotherapy alone.

Tumor response to treatment was increased by 34% among patients treated with Astragalus-based herbal medicine and chemotherapy.

Patients treated with Astragalus-based herbal medicine and chemotherapy were more likely to experience a stable or improved level of functioning.

While these findings suggest a potential benefit of Astragalus-based Chinese herbal medicine, the researchers caution that several of the evaluated studies were of low quality. Quality was assessed on the basis of whether the study was described as randomized, whether the method of randomization was reported, whether patients and physicians were blinded to the patient’s treatment status, and whether the researchers accounted for patients who dropped out of the study. On a scale of 0 to 5, with 5 being the best, only three studies were given a score of 2 or higher. The quality of the remaining studies was rated as 0 or 1.

The researchers conclude that “Astragalus-based Chinese herbal medicine may increase effectiveness (by improving survival, tumor response, and performance status) and reduce toxicity of standard platinum-based chemotherapy for advanced non-small-cell lung cancer.” They also note, however, that “confirmation of these conclusions in rigorously controlled, randomized trials is required before more firm conclusions about this therapy can be drawn.”

Comments: Since the results of treating NSCLC with chemotherapy are so dismal these findings need to be followed up with carefully performed clinical trials.

Reference: McCulloch M, See C, Shu X-j et al. Astragalus-Based Chinese Herbs and Platinum-Based Chemotherapy for Advanced Non-Small-Cell Lung Cancer: Meta-Analysis of Randomized Trials. Journal of Clinical Oncology . 2006;24:419-430.