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ORIGINAL ARTICLE
Year : 2015  |  Volume : 52  |  Issue : 5  |  Page : 29-31
 

A meta-analysis of lentinan injection combined with chemotherapy in the treatment of nonsmall cell lung cancer


1 Department of Oncology, Tianjin Union Medical Center, Tianjin, China
2 Department of Thoracic Surgery, Tianjin Union Medical Center, Tianjin, China

Date of Web Publication3-Nov-2015

Correspondence Address:
H Wang
[email protected]
China
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.168953

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 » Abstract 

Objective: To systematic review and analysis the clinical efficacy and toxicity of lentinan injection combined with chemotherapy in the treatment of nonsmall cell lung cancer (NSCLC). Materials and Methods: The databases of PubMed and CNKI were electronic searched with the free text word of lung cancer/NSCLC and lentinan. The prospective clinical study reporting the clinical efficacy and safety of lentinan injection combined with chemotherapy in the treatment of NSCLC were reviewed and included in this meta-analysis. The combined treatment efficacy and toxicity of lentinan injection combined with chemotherapy were pooled by Stata 11.0 software. Results: Twelve clinical studies of lentinan injection combined with chemotherapy in the treatment of NSCLC with 458 controls and 492 NSCLCs patients were finally included in this meta-analysis. The pooled results indicated that the objective response rate was significant improved in the lentinan injection combined chemotherapy group compared with chemotherapy group only (relative risk [RR] = 1.31, 95% confidence interval [CI]: 1.14–1.52). The chemotherapy-related toxicity of III/IV gastrointestinal reaction (RR = 0.54, 95% CI: 0.43–0.68) and III/IV granulocytopenia (RR = 0.65, 95% CI: 0.51–0.70) were significant decreased in the combined group. Conclusion: Lentinan injection combined chemotherapy significant increase the objective response rate and decreased the chemotherapy-related toxicity.


Keywords: Efficacy, lentinan injection, meta-analysis, nonsmall cell lung cancer, side effects


How to cite this article:
Yin X, Ying J, Li L, Zhang H, Wang H. A meta-analysis of lentinan injection combined with chemotherapy in the treatment of nonsmall cell lung cancer. Indian J Cancer 2015;52, Suppl S1:29-31

How to cite this URL:
Yin X, Ying J, Li L, Zhang H, Wang H. A meta-analysis of lentinan injection combined with chemotherapy in the treatment of nonsmall cell lung cancer. Indian J Cancer [serial online] 2015 [cited 2021 Jul 31];52, Suppl S1:29-31. Available from: https://www.indianjcancer.com/text.asp?2015/52/5/29/168953



 » Introduction Top


According to the world-wide cancer statistical analysis, lung cancer is the leading cause of cancer-related death with more than 200,000 people diagnosed of lung cancer per year in the United States.[1],[2] It was reported that about 80% of the diagnosed nonsmall cell lung cancer (NSCLC) patients were in advance or locally advanced stages.[3] Most of them lost the opportunity of surgery. Other 20% of the patients who received operation should also receive the postsurgery adjuvant chemotherapy. Recently, some clinical studies reported that the lentinan injection combined chemotherapy can improve the response rate and decrease the chemotherapy-associated toxicity. However, the number of patients included in these studies was relative small with the controversial conclusion. Hence, we searched the PubMed, CNKI databases and included the prospective clinical studies about lentinan injection combined chemotherapy in the treatment of NSCLC. The response rate and chemotherapy toxicity were pooled by statistical software.


 » Materials and Methods Top


Paper searching strategy

The prospective clinical studies of lentinan injection combined chemotherapy in the treatment of NSCLC were searched in the databases of PubMed and CNKI. The inclusion criteria were as flows: (1) The patients were diagnosed of NSCLC; (2) the study design was prospective clinical study; (3) the treatment was chemotherapy versus chemotherapy plus lentinan injection; (4) the outcome was objective response rate and chemotherapy-related toxicity. The searching procedure and studies screening were done by two reviewers independently.

Statistics

The data were analyzed using Stata 10.0 software (http://www.stata.com; Stata Corporation, College Station, TX, USA). The clinical efficacy was calculated as the relative risk (RR) with the 95% confidence interval (CI). The Egger's tests were used for each effect to evaluate possible publication bias as described by Egger's test.


 » Results Top


General characteristics

Twelve clinical studies of lentinan injection combined chemotherapy in the treatment of NSCLC with 458 controls and 492 NSCLCs were finally included in this meta-analysis. The main characteristics of the included each individual study is shown in [Table 1]. All of the 12 studies were come from China. Four studies reported the Navelbine+Cisplatin (NP) chemotherapy regimen, five studies reported the GP chemotherapy regimen and three trails reported the TP chemotherapy regimen. The treatment course ranges from 2 to 8 weeks.
Table 1: General information of included trials

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Treatment efficacy

Twelve studies reported the treatment objective response rate. The pooled results indicated that the objective response rate was significantly improved in the lentinan injection combined chemotherapy group compared with chemotherapy group only (RR = 1.31, 95% CI: 1.14–1.52). For subgroup analysis, the NP chemotherapy combined with lentinan injection does not improve the objective response rate (RR = 1.14, 95% CI: 1.14–1.52, P > 0.05); but the objective response rate can be significantly improved by GP or TP combined with lentinan injection with RR of 1.39 (95% CI: 1.13–1.71) and 1.39 (95% CI: 1.03–1.18), [Figure 1]. The publication bias was evaluated by funnel plot and Egger's test which showed no significant publication bias (P > 0.05), [Figure 2].
Figure 1: The forest plot for efficacy of lentinan injection combined chemotherapy in the treatment of nonsmall cell lung cancer

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Figure 2: Funnel plot for publication bias

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Chemotherapy related toxicity

Nine articles reported the chemotherapy toxicity of gastrointestinal reaction, the pooled results indicated that the Grade III/IV gastrointestinal reaction was significant decreased in patients treated with chemotherapy plus lentinan injection (RR = 0.54, 95% CI: 0.43–0.68); eight study provided the data of chemotherapy-related granulocytopenia with the pooled RR = 0.65 (95% CI: 0.51–0.70) which indicated that the combined treatment can significant decrease the chemotherapy-related toxicity, [Figure 3]. Moreover, no publication bias was found in the chemotherapy-related toxicity assessment was found (P > 0.05) [Figure 4].
Figure 3: Forest plot of chemotherapy related toxicities

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Figure 4: Funnel plot of publication bias of chemotherapy related toxicities

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 » Discussion Top


Lung cancer is the leading cause of cancer-related death globally. And, it was generally divided into two subgroups according to the pathology type. The SCLC and the nonsmall cell lung carcinoma. The NSCLC, accounting for 80% of all the lung cancer is generally treated with surgery for early stage. But for advanced stage, the major treatment was systematic chemotherapy.

Lentinan is an intravenous anti-tumor polysaccharide isolated from the fruit body of shiitake (Lentinula edodes). Lentinan has been approved as an adjuvant for stomach cancer since 1985.[16] Lentinan is one of the host-mediated anti-cancer drugs, which has been shown to affect host defense immune systems.[17]

Recently, some prospective clinical studies showed that lentinan combined with chemotherapy can improve the clinical efficacy and decrease the chemotherapy-associated toxicity. Rongfang et al.[8] reported the clinical effect of lentinan combined with gemcitabine and cisplatin in the treatment of NSCLC. In their study, the combined treatment cannot significant improve the clinical efficacy (P > 0.05), 1-year survival rate and median survival time (P > 0.05). However, the chemotherapy-related toxicity such as III/IV gastrointestinal reaction and granulocytopenia was significant decreased (P < 0.05). Zhiying et al., and his college reported the clinical efficacy and safety of lentinan combined GP chemotherapy regimens in the treatment of NSCLC. They found that the response rate in the combined treatment group was significant improved (P < 0.05). And the chemotherapy-related toxicity was also decreased in the combined group compared to single chemotherapy group (P < 0.05).

In our meta-analysis, 12 clinical studies of lentinan injection combined chemotherapy in the treatment of NSCLC with 458 controls and 492 NSCLCs were finally included in this meta-analysis. The pooled results indicated that the objective response rate was significantly improved in the lentinan injection combined chemotherapy group compared with chemotherapy group only (RR = 1.31, 95% CI: 1.14–1.52). The chemotherapy-related toxicity of III/IV gastrointestinal reaction (RR = 0.54, 95% CI: 0.43–0.68) and III/IVgranulocytopenia (RR = 0.65, 95% CI: 0.51–0.70) were significant decreased in the combined group. Hence, we believe that lentinan injection combined chemotherapy significant increase the objective response rate and decreased the chemotherapy-related toxicity. However, some limitations existed in this meta-analysis: (1) The quality of include study was relatively low; (2) all of the studies came from China with publication language of Chinese; (3) the patients number of each included study was relative low.

 
 » References Top

1.
Siegel R, Naishadham D, Jemal A. Cancer statistics, 2012. CA Cancer J Clin 2012;62:10-29.  Back to cited text no. 1
    
2.
Chen W, Zheng R, Zhang S, Zou X, Zhao P, He J. Lung cancer incidence and mortality in China, 2009. Thorac Cancer 2013;4:102-8.  Back to cited text no. 2
    
3.
Zeng H, Zheng R, Zhang S, He J, Chen W. Lung cancer incidence and mortality in China, 2008. Thorac Cancer 2013;4:53-8.  Back to cited text no. 3
    
4.
Hong L, Shuqin W, Haimei Z. Lentinan injection combined NP chemotherapy regimen in the treatment of non-small cell lung cancer: Report of 63 cases. J Xinjiang Med Univ 2008;31:92-3.  Back to cited text no. 4
    
5.
Shi X, Qian D, Yang Q. Lentinan combined with chemotherapy in the treatment of advanced non-small cell lung cancer. Chin J Clin Oncol 2007;16:946-8.  Back to cited text no. 5
    
6.
Xueyuan W. Lentinan combined with vinorelbine and cisplatin in the treatment of elderly patients with non-small cell cancer. China Foreign Med Treat 2009;21:76-7.  Back to cited text no. 6
    
7.
Suliang S, Jianan H. Clincial efficacy and safety of lentinan combined with NP chemotherapy regimen in the treatment of non-small cell lung cancer. Clin Focus 2009;6:501-4.  Back to cited text no. 7
    
8.
Rongfang J, Xiaoming T, Wei L, Lianqiang J. Clincial effect of lentinan combined with gemcitabine and cisplatin in the treatment of non-small cell lung cancer. Med J Qilu 2010;8:132-4.  Back to cited text no. 8
    
9.
Wang J, Zhang Y, Zhao H. The influence of immune function and therapeutic and adverse effect of lentinan combined with chemotherapy in advanced non-small cell lung cancer. Chin J Clin Oncol 2011;06:15-7.  Back to cited text no. 9
    
10.
Jianqing C. Lentinan combined with chemotherapy in the treatment of non-small cell lung cancer. Suzhou Univ J Med Sci 2008;28:306-7.  Back to cited text no. 10
    
11.
Zhiying L, Yingqun Z, Ping Z, Zhe L, Longpei H. Lentinan combined GP chemotherapy regiment in the treatment of non-small cell lung cancer. J Pract Med 2009;25:3480-2.  Back to cited text no. 11
    
12.
Xulin Z, Lei M. Toxicity-reducing and efficacy-enhancing action of lentinan with chemotherapy in the treatment of advanced non-small cell lung cancer. Chin J Clin Ration Drug Use 2011;04:20-1.  Back to cited text no. 12
    
13.
Xichun D. Clincial observation of lentinan combined chemotherapy in the treatment of non-small cell lung cancer. J Clin Med Pract 2010;14:73-7.  Back to cited text no. 13
    
14.
Haimei Z. Lentinan combined with chemotherapy in treatment of advanced non-small cell lung cancer. Chin J Cancer Biother 2009;16:523-5.  Back to cited text no. 14
    
15.
Jianhong Q. Lentinan adjuvant treatment of non-small cell lung cancer: Reported of 34 cases. Chin J Mod Drug Appl 2010;04:114-5.  Back to cited text no. 15
    
16.
Ina K, Kataoka T, Ando T. The use of lentinan for treating gastric cancer. Anticancer Agents Med Chem 2013;13:681-8.  Back to cited text no. 16
    
17.
Chihara G, Hamuro J, Maeda YY, Shiio T, Suga T, Takasuka N, et al. Antitumor and metastasis-inhibitory activities of lentinan as an immunomodulator: An overview. Cancer Detect Prev Suppl 1987;1:423-43.  Back to cited text no. 17
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]
 
 
    Tables

  [Table 1]

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