Efficacy and Safety of Commercial Chinese Polyherbal Preparation Combined with Oxaliplatin-Based Chemotherapy for Gastric Cancer: A Systematic Review and Network Meta-analysis

Bei Pan^1,2,3Honghao Lai^2,3Ning Ma^2,3Xin He^2,3Xiaowei Liu^3,4Xiyuan Deng⁵Jinhui Tian^1,3Long Ge^2,3*Kehu Yang^1,2,3

• ¹Evidence-Based Medicine Center, School of Basic Medical Sciences, Lanzhou University, Lanzhou, China
• ²Centre for Evidence-Based Social Science/Center for Health Technology Assessment, School of Public Health, Lanzhou University, Lanzhou, China
• ³Gansu Key Laboratory of Evidence-Based Medicine, Lanzhou University, Lanzhou, China
• ⁴The first Clinical Medical College of Lanzhou University, Lanzhou, China
• ⁵Gansu Provincial Maternity and Child Care Hospital, Lanzhou, China

Objective: To evaluate the efficacy, safety, and quality of evidence for commercial Chinese polyherbal preparations (CCPPs) in combination with oxaliplatin-based chemotherapy (OX) for gastric cancer (GC). Methods: We searched six databases for randomized controlled trials (RCTs) comparing CCPPs plus OX to other active treatments for GC. The risk of bias was assessed using a modified version of Cochrane risk of bias tool. A frequentist network meta-analysis using a random-effects model was performed to estimate the relative effectiveness between treatments. We used GRADE to assess the certainty of evidence, to categories the interventions, and to present the findings. Results: One-hundred-and-eighty-nine RCTs involving 15,320 participants that reported 27 CCPPs were identified. Moderate to high certainty evidence showed that Compound Mylabris preparations (Disease Control Rate (DCR): 1.51, 1.13 to 2.03) is among the most effective CCPPs for improving DCR, while Kangai Injection (objective response rate (ORR): 1.40, 1.28 to 1.77; quality of life (QoL): 1.46, 1.11 to 1.94), Huachansu preparations (ORR: 1.28, 1.15 to 1.43), Ya Dan Zi Oil Emulsion Injection (QoL: RR 1.26, 1.06 to 1.51), Aidi Injection (QoL: 1.30, 1.13 to 1.50), Lentinan (QoL: 1.27, 1.05 to 1.54), and Yangzheng Xiaoji Capsules (ORR: 1.36, 1.05 to 1.77) showed intermediate efficacy for ORR and QoL. Regarding immune function improvement, with moderate to high certainty evidence, Shenmai Injection (CD3+: 10.03, 1.69 to 18.37; CD4+: 8.33, 0.64 to 16.02), Ginseng Polysaccharide Injection (CD3+: 10.55, 1.89 to 19.21), Huachansu preparations (CD3+: 7.42, 2.51 to 12.34), Kangai Injection (CD3+: 11.65, 6.81 to 16.50; CD4+/ CD8+: 0.25, 0.02 to 0.47), Lentinan (CD4+: 9.43, 3.78 to 15.08), Shenqi Fuzheng Injection (CD4+: 5.72, 3.68 to 7.76), and Yangzheng Xiaoji Capsules (CD3+: 9.32, 0.84 to 17.80) showed improvements in specific immune parameters. Conclusion: No CCPP was optimal for all endpoints, Compound Mylabris showed superior tumor response, and Kangai Injection offered the most favorable risk-benefit profile, providing broad efficacy and statistically significantly reducing AEs. The choice of adjuvant CCPP should be individualized based on specific therapeutic priorities, balancing efficacy and safety.