Efficacy and Safety of Chinese Herbal Injection Thoracic Perfusion combined with Cisplatin chemotherapy for Lung Cancer Malignant Pleural Effusion: A Systematic Review and Meta-Analysis

Purpose To evaluate the efficacy and safety of Chinese herbal injection thoracic perfusion combined with cisplatin chemotherapy for lung cancer patients with MPE. Method Eight databases were searched for articles published from inception to August 20, 2022 for randomized-controlled trials (RCTs) that are relevant. The included studies were reviewed by two investigators, with relevant data extracted independently. Primary outcome was identified as objective response rate (ORR), while secondary outcomes were identified as quality of life (QOL) and adverse reactions. Quality of the included trials was assessed through risk of bias assessment of the Cochrane risk-of-bias tool. The Revman5.3 and Stata17.0 software were used to calculate risk ratio (RR) at 95% confidence intervals (CI) for binary outcomes. Results 29 RCTs involving 1887 patients were included in this study. Compared with patients treated with cisplatin thoracic perfusion alone, those with Chinese herbal injection and cisplatin thoracic perfusion had better therapeutic effects (RR=1.44, 95% CI: 1.35∼1.53, P = 0.000), higher KPS score (RR = 1.47, 95%CI: 1.34∼1.61, P = 0.0000), lower digestive tract reaction(RR = 0.56, 95%CI: 0.48∼0.67, P = 0.000), bone marrow suppression (RR = 0.50, 95% CI: 0.43∼0.59, P =0.000) and chest pain reactions (RR = 0.65, 95%CI: 0.47∼0. 89, P = 0.007). Conclusion The systematic review indicated that Chinese herbal injection thoracic perfusion combined with cisplatin chemotherapy may improve therapeutic effect, quality of life, and reduce adverse reactions. More large-scale and higher quality RCTs are warranted to support our findings. Systematic Review Registration: PROSPERO, identifier CRD42022347345.