Examining patterns of traditional chinese medicine use in pediatric oncology: A systematic review, meta-analysis and data-mining study

Background Traditional Chinese medicine(TCM)is becoming a popular complementary approach in pediatric oncology.However,few or no meta-analyses have focused on clinical studies of the use of TCM in pediatric oncology.Objective We explored the patterns of TCM use and its efficacy in children with cancer,using a systematic review,meta-analysis and data mining study.Search strategy We conducted a search of five English(Allied and Complementary Medicine Database,Embase,PubMed,Cochrane Central Register of Controlled Trials,and ClinicalTrials.gov)and four Chinese databases(Wanfang Data,China National Knowledge Infrastructure,Chinese Biomedical Literature Database,and VIP Chinese Science and Technology Periodicals Database)for clinical studies published before October 2021,using keywords related to“pediatric,”“cancer,”and“TCM.”Inclusion criteria We included studies which were randomized controlled trials(RCTs)or observational clinical studies,focused on patients aged<19 years old who had been diagnosed with cancer,and included at least one group of subjects receiving TCM treatment.Data extraction and analysis The methodological quality of RCTs and observational studies was assessed using the six-item Jadad scale and the Effective Public Healthcare Panacea Project Quality Assessment Tool,respectively.Meta-analysis was used to evaluate the efficacy of combining TCM with chemotherapy.Study outcomes included the treatment response rate and occurrence of cancer-related symptoms.Association rule mining(ARM)was used to investigate the associations among medicinal herbs and patient symptoms.Results The fifty-four studies included in this analysis were comprised of RCTs(63.0%)and observational studies(37.0%).Most RCTs focused on hematological malignancies(41.2%).The study outcomes included chemotherapy-induced toxicities(76.5%),infection rate(35.3%),and response,survival or relapse rate(23.5%).The methodological quality of most of the RCTs(82.4%)and observational studies(80.0%)was rated as“moderate.”In studies of leukemia patients,adding TCM to conventional treatment significantly improved the clinical response rate(odds ratio[OR]=2.55;95%confidence interval[CI]=1.49-4.36),lowered infection rate(OR=0.23;95%CI=0.13-0.40),and reduced nausea and vomiting(OR=0.13;95%CI=0.08-0.23).ARM showed that Radix Astragali,the most commonly used medicinal herb(58.0%),was associated with treating myelosuppression,gastrointestinal complications,and infection.Conclusion There is growing evidence that TCM is an effective adjuvant therapy for children with cancer.We proposed a checklist to improve the quality of TCM trials in pediatric oncology.Future work will examine the use of ARM techniques on real-world data to evaluate the efficacy of medicinal herbs and drug-herb interactions in children receiving TCM as a part of integrated cancer therapy.

Photodynamic therapy-mediated modulation of inflammatory cytokine production by Epstein–Barr virus-infected nasopharyngeal carcinoma cells

Nasopharyngeal carcinoma(NPC)is a malignant disease associated with Epstein–Barr virus(EBV)infection.This study aims to examine the effects of EBV infection on the production of proinflammatory cytokines in NPC cells after the Zn-BC-AM photodynamic therapy(PDT)treatment.Cells were treated with the photosensitiser Zn-BC-AM for 24 h before light irradiation.Quantitative ELISA was used to evaluate the production of cytokines.Under the same experimental condition,HK-1-EBV cells produced a higher basal level of IL-1a(1561 pg/ml),IL-1b(16.6 pg/ml)and IL-8(422.9 pg/ml)than the HK-1 cells.At the light dose of 0.25–0.5 J/cm2,Zn-BC-AM PDT-treated HK-1-EBV cells were found to produce a higher level of IL-1a and IL-1b than the HK-1 cells.The production of IL-1b appeared to be mediated via the IL-1b-converting enzyme(ICE)-independent pathway.In contrast,the production of angiogenic IL-8 was downregulated in both HK-1 and HK-1-EBV cells after Zn-BC-AM PDT.Our results suggest that Zn-BC-AM PDT might indirectly reduce tumour growth through the modulation of cytokine production.