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.

Genotypes versus phenotypes:The potential paradigm shift in the diagnosis and management of pediatric neoplasms

The gold standard of cancer diagnosis has long been based on histological characteristics.With the rapid advancement of genetic medicine,such standard algorithm of diagnostic approach is facing a challenge.The genetic findings have been changed from being a"supporting character"into the role of a"main character".More and more disease diagnosis and classification has to be defined by genetic basis.In this article,we focus on the challenges in the field of pediatric oncology.We cited 2 scenarios where genetic information plays a pivotal role in identifying the underlying pathology.The first scenario is that same genetic mutation can lead to variable clinical phenotypes,this includes EWSR1-PATZ1 fusion related neoplasms;BCOR neoplasms;and GATA-2 deficiency related immunodeficiency and myelodysplastic syndrome.Another scenario is relatively more common that is the same clinical and histopathological phenotype with different underlying genotypes.The genotypes actually impact on the treatment response and outcome.We used medulloblastoma as an example.In fact,we can also find similar scenario in many pediatric cancers such as Ewing sarcoma,ependymoma,etc.The essence of this article is to remind clinicians of the rapid development in genetic medicine and it has been reshaping the landscape of the modern disease classification and therapeutic approach.In the near future,it may even lead to a paradigm shift in our disease diagnostic algorithm.

Exosomes derived from nasopharyngeal carcinoma cells induce IL-6 production from macrophages to promote tumorigenesis

Chronic inflammation in the tumor microenvironment can promotes tumorigenesis.Various immune cells,including macrophages,can infiltrate into the tumor microenvironment and secrete abundant inflammatory cytokines.1 Interleukin-6(IL-6)is a major inflammatory cytokine that is widely involved in the tumorigenesis of many cancers,including nasopharyngeal carcinoma(NPC).2 In NPC patients,serum IL-6 was elevated and positively correlated with poor prognosis,suggesting that IL-6 may play a critical role in NPC progression.2,3 Indeed,previous studies demonstrated that IL-6 could activate signal transducer and activator of transcription 3(STAT3)and promote the proliferation,migration,and invasion of NPC cells.2 However,the mechanism underlying the upregulation of IL-6 in NPC remains elusive.