Efficacy of Traditional Chinese Medicines in Preventing Oxaliplatin-induced Peripheral Neurotoxicity in Cancer Patients:A Network Meta-analysis

Objective Oxaliplatin-induced peripheral neurotoxicity(OIPN) is the main limitation for its continuation in cancer patients.Traditional Chinese medicines(TCMs) have been used to prevent OIPN in China and have been demonstrated to be effective.However,due to the lack of direct comparison among TCMs,it remains unclear that which TCM is the best for OIPN prevention.Consequently,the present study aimed to compare the relative efficacies of TCMs to find out the best TCM by applying a network meta-analysis.Methods Studies were identified by searching PubMed,EMbase,Cochrane Libraries,CNKI,WanFang,and WeiPu database from January 1990 to May2016.Randomized controlled trials(RCTs) that evaluated the efficacy of TCMs in preventing OIPN in cancer patients were included.Statistical analysis was performed with ADDIS 1.1 6.6.Results Twenty-five RCTs(1572 patients) involving five TCMs were included.The results of network meta-analyses showed that compared with oxaliplatin-based chemotherapy alone,the combination with Huangqi Injection(HQI),Shenmai Injection(SMI),Shenfu Injection(SFI),Buyang Huanwu Decoction(BHD),and Huangqi Guizhi Wuwu Decoction(HGWD) could decrease the overall OIPN incidence and the severe OIPN incidence in cancer patients.In addition,probability ranking results showed the order of efficacy in preventing overall OIPN incidence was HQI > HGWD > SFI =SMI > BHD,while the order of efficacy in preventing severe OIPN incidence was HQI >HGWD > BHD > SFI = SMI.Conclusion All five TCMs are effective neuroprotective agents against OIPN.Among these TCMs,HQI and HGWD were superior to others in clinical efficacy.Moreover,Astragalus membranaceus might be a more promising herb for the OIPN prevention.However,more direct head-to-head RCTs with high quality and large sample size are still needed to further confirm the conclusion.