Moxibustion for the treatment of chemotherapy-induced leukopenia: a systematic review of randomized clinical trials

Moxibustion combined with guasha therapy for recurrent neutropenia following multiple cycles of chemotherapy of ovarian cancer: A case report

Neutropenia, a common side effect of chemotherapy for ovarian cancer, was observed in a 47-year-old female patient undergoing a six-cycle chemotherapy regimen. She experienced recurrent neutropenia and leukopenia but refused granulocyte colony-stimulating factor (G-CSF) due to severe bone pain and high costs. Moxibustion combined with guasha therapy (MGT) was administered each time neutropenia occurred. The treatment involved guasha therapy on the bladder meridian (BL) and the governor vessel (GV), followed by moxibustion at Zhongwan (CV 12), Guanyuan (CV 4), and Shenzhu (GV 12) points over 2-3 days. This approach led to the recovery of neutrophil and leukocyte counts, enabling the patient to complete six chemotherapy cycles without G-CSF. These findings suggest that MGT may enhance neutrophil and leukocyte counts in patients with chemotherapy-induced myelosuppression, presenting a potential alternative for those intolerant to G-CSF. However, further high-quality research is needed to confirm its efficacy.

Spano M, Cohen A, Geng Y, Cohen L. Systematic Review and Meta-analysis of Acupuncture for Modulation of Immune and Inflammatory Markers in Cancer Patients

Introduction: Inflammation is associated with tumor initiation, and existing tumors are associated with immune suppression locally and systemically. Cancer treatment is also associated with immune suppression. This review evaluates evidence related to the use of acupuncture for modulation of inflammation and the immune system in cancer patients. Methods: Nine databases were searched for prospective, randomized, controlled trials evaluating the use of acupuncture for modulation of the immune system in cancer patients through March 2024. Only studies involving needle insertion into acupuncture points were included. No language limitations were applied. Studies were assessed for risk of bias (ROB) according to Cochrane criteria. The primary outcomes were levels of immune and inflammatory markers. Results: Of 3607 articles identified, 1526 duplicates were omitted, and 2261 articles were screened. Sixty-four (58 Chinese, 6 English) publications met all inclusion criteria and were evaluated for ROB. Forty-seven studies were rated as unclear ROB, and nine studies were rated as high ROB. However, when the blinding and allocation concealment criteria were removed, 12 studies had low ROB. Fifty-six studies were included in the meta-analysis, which found that acupuncture significantly increased interferon gamma (IFN-γ; P < .01), natural killer (NK) cells (P < .01), immunoglobulin G (IgG; P = .04), immunoglobulin M (IgM; P = .04), CD3 cells (P < .01), CD4 cells (P < .01), and the CD4/CD8 cell ratio (P < .01), and significantly lowered interleukin (IL)-1 (P = .01), IL-4 (P < .01), IL-6 (P < .01), and C-reactive protein (P < .01). Yet except for IFN-γ, there was high heterogeneity of results between studies. No significant differences were found in white blood cells, CD-8, neutrophil levels, IL-2, IL-10, or tumor necrosis factor alpha (TNF-α). Conclusion: The current evidence is insufficient to either support or refute the immunomodulatory effects of acupuncture in cancer patients due to no studies fully meeting the low ROB criterion. The preliminary data, however, are promising. Future studies that are higher powered, with low ROB designs, are warranted.

Chemotherapy Induced Neutropenia, Febrile-Neutropenia and Determinants Among Solid Cancer Patients Attending Oncology Unit of a Tertiary Care Teaching Hospital in Ethiopia

Background

Globally the incidence of cancer is about 19.3 million new cases per year. Chemotherapy is among the standard treatments for cancer but neutropenia and febrile neutropenia are the most common side effects.

Objective

To assess the incidences of chemotherapy-induced neutropenia, febrile-neutropenia and associated factors in solid cancer patients attending Oncology unit of St. Paul Hospital Millennium Medical College in Addis Ababa, Ethiopia.

Methods

In this institution-based longitudinal study conducted from February to September, 2020 at one of the largest teaching and referral hospitals of Ethiopia, 101 patients who were diagnosed with any type of solid cancer were recruited using convenience sampling method. Patients were followed-up until they completed five cycles of chemotherapy. Data were analyzed using SPSS version 23 software. Paired sample t-test was used to compare the pre- and post-treatment results. Chi-squared test was employed to determine associated factors of neutropenia, and p-values less than 0.05 were taken as statistically significant.

Results

Of the total 101 participants, 98 were eligible per inclusion criteria and 6 (6.1%) of them died during the study period. The age of the participants ranged from 16-84 years with a mean age of 45. Of them, 48 (49.0%) were in the age group of 16-44 years, 73 (74.5%) were female, 66 (67.3%) were married, and 42.9% attained primary education. Among 92 patients, the incidence of neutropenia was 65 (70.7%) and the incidence of febrile neutropenia was 46 (50.0%). Adriamycin + cyclophosphamide and Adriamycin + cyclophosphamide + paclitaxel were the most commonly used anti-cancer treatments in this study. None of the tested factors were associated with chemo-induced neutropenia.

Conclusion

More than two thirds of the patients had chemotherapy associated neutropenia while half of the patients had febrile neutropenia; close monitoring of such patients is warranted.

Moxibustion for the Treatment of Cancer and its Complications: Efficacies and Mechanisms

Cancer treatment remains a significant challenge for the medical community, and improved therapies are necessary to treat cancer and its associated complications. Current anticancer therapies often have significant side effects, underscoring the need for new treatment options. Moxibustion is a representative external therapy used in traditional Chinese medicine. This review examines clinical studies demonstrating moxibustion's ability to improve the efficacy of radiotherapy and chemotherapy and control tumor progression. Moxibustion can prevent and treat various complications of cancer, including cancer-related or therapy-induced gastrointestinal symptoms, myelosuppression, fatigue, pain, and postoperative lymphedema. has also been shown to enhance the quality of life for cancer patients. However, very few studies have investigated the underlying mechanisms for these effects, a topic that requires systematic elucidation. Evidence has shown that moxibustion alone or combined with chemotherapy can improve survival and inhibit tumor growth in cancer-bearing animal models. The anticancer effect of moxibustion is associated with alleviating the tumor immunosuppressive and vascular microenvironments. Additionally, the therapeutic effects of moxibustion may originate from the heat and radiation produced during the combustion process on acupoints or lesions. This evidence provides a scientific basis for the clinical application of moxibustion in anticancer treatment and reducing the side effects of cancer therapies and helps promote the precise application of moxibustion in cancer treatment.

Acupuncture combined with traditional Chinese medicine preparation for the treatment of marrow suppression after chemotherapy: A protocol for systematic review and meta-analysis

BACKGROUND

From the perspective of evidence-based medicine, the efficacy and safety of combined therapy for marrow suppression after chemotherapy is still unclear. Given that there is no high-quality meta-analysis to incorporate existing evidence, the purpose of this protocol is to design a systematically review and meta-analysis of the level I evidence to ascertain the efficacy and safety of acupuncture combined with traditional Chinese medicine preparation for marrow suppression after chemotherapy.

METHODS

The following databases will be searched electronically by keyword combination mode: 4 British literature databases including PubMed, EMBASE, Scopus, and Cochrane Library, and 4 Chinese literature databases, including Chinese national knowledge infrastructure, VIP, and Wan fang database. The randomized controlled trials on acupuncture plus traditional Chinese medicine preparation for marrow suppression after chemotherapy will be included. The primary outcome is the elevation of hemoglobin, platelets, leukocytes, and neutrophils. The other outcomes include clinical symptoms, quality of life, and absolute value of reticulocyte. Risk bias analysis of the studies will be performed independently by 2 reviewers using the Cochrane Risk of Bias Assessment Tool.

RESULTS

The review will add to the existing literature by showing compelling evidence and improved guidance in clinic settings.

CONCLUSION

This protocol will provide a reliable theoretical basis for the following research.

Efficacy and Safety of Acupuncture-Moxibustion Therapy on Chemotherapy-Induced Leukopenia: A Systematic Review and Meta-Analysis

BACKGROUND

Acupuncture-moxibustion therapy (AMT), as an integral part of complementary and alternative medicine, has been used for centuries in treatment of numerous diseases. Nevertheless, there is no available supportive evidence on the efficacy and safety of acupuncture-moxibustion therapy in patients with chemotherapy-induced leukopenia (CIL). The purpose of this study is to evaluate the efficacy and safety of acupuncture-moxibustion therapy in treating chemotherapy-induced leukopenia.

METHODS

Relevant studies were searched in nine databases up to September 19, 2020. Two reviewers independently screened the studies for eligibility, extracted data, and assessed the methodological quality of selected studies. Meta-analysis of the pooled mean difference (MD) and risk ratio (RR) with their respective 95% confidence intervals (CI) were calculated.

RESULTS

17 studies (1206 patients) were included, and the overall quality of the included studies was moderate. In comparison with medical therapy, AMT has a better clinical efficacy for CIL (RR, 1.24; 95% CI, 1.17-1.32; P < 0.00001) and presents advantages in increasing leukocyte count (MD, 1.10; 95% CI, 0.67-1.53; P < 0.00001). Also, the statistical results show that AMT performs better in improving the CIL patients' Karnofsky performance score (MD, 5.92; 95% CI, 3.03-8.81; P < 0.00001).

CONCLUSION

This systematic review and meta-analysis provides updated evidence that AMT is a safe and effective alternative for the patients who suffered from CIL.

Acupuncture for the treatment of marrow suppression after chemotherapy: A protocol for systematic review and meta-analysis

BACKGROUND

Cancer continues to be a severe global health problem and the leading cause of death worldwide. Chemotherapy as the main treatment has various side effects, of which marrow suppression is the most common one. Acupuncture had shown clinical effects for marrow suppression after chemotherapy in many studies. However, the efficacy and safety of acupuncture therapy for marrow suppression after chemotherapy remains unclear.

OBJECTIVE

This protocol aims to evaluate the efficacy and safety of acupuncture for marrow suppression after chemotherapy according to the existing randomized controlled trials.

METHODS AND ANALYSIS

The randomized controlled trials on acupuncture therapy for marrow suppression after chemotherapy will be searched in the database of Embase, PubMed and Cochrane Library, Allied and Complementary Medicine Database (AMED), Chinese Biomedical Literature Database (CBM), China Science and Technology Journal Database (VIP), China National Knowledge Infrastructure (CNKI), WanFang Database (WF), and related registration platforms (WHO ICTRP, Clinical Trials, and Chinese Clinical Trial Register [ChiCTR]), Grey Literature Database from inception to 1 August 2020. The primary outcomes will be assessed using white blood cell (WBC) count, platelet count, hemoglobin count and the number of neutrophils (N). Review Manager V.5.3 software will be applied for statistical analyses. We will measure the risk of bias of the included studies with Cochrane Collaboration Risk of Bias Tool. Finally, Grades of Recommendation, Assessment, Development, and Evaluation (GRADE) will be used to grade the overall quality of evidence. And we will use the intra-group correlation coefficient to assess the consistency of reviewers.

RESULT

This systematic review and meta-analysis will put a high-quality synthesis of the efficacy and safety of acupuncture treatment in marrow suppression after chemotherapy.

CONCLUSION

The conclusion of this systematic review will provide evidence to assess acupuncture therapy is an efficacy and safe intervention to treat and control marrow suppression after chemotherapy.

PROSPERO REGISTRATION NUMBER

PROSPERO CRD42020163336.

An Overview of Systematic Reviews: Complementary Therapies for Cancer Patients

Introduction: This article critically examines the systematic reviews (SR) and meta-analysis (MA) of complementary therapies for cancer patients to appraise the evidence level, and offers suggestions for future research and practice. Methods: The Cochrane Library and MEDLINE were searched from their inception to January 2018, to identify SR and MA of complementary therapies available for cancer patients. Final selected SR and MA were methodologically evaluated for their quality by applying the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR2) instrument. Data extraction and risk of quality assessments were performed by 2 independent reviewers. Results: A total of 104 studies were included in the analysis. The majority of the individual clinical trials included in the SR and MA were performed in China (48%) and the United States (26.9%). Breast cancer was the most studied cancer type (25%), and acupuncture was the most studied intervention (21%). Side effects of cancer such as pain, depression, and fatigue were effectively managed with complementary therapies. The methodologically problematic items included not listing the excluded studies and lack of protocol or protocol registration. Conclusions: With increasing interest in research, complementary therapies appear to be beneficial in reducing side effects and raising the quality of life of cancer patients. Complementary therapies have generally been studied for all cancers, with acupuncture being the most researched, regardless of the cancer type. Since AMSTAR2 is a stricter assessment tool than before, future studies need to consider the risk of methodological bias with caution and discuss appropriate overall quality assessment tools.

Preformulation Studies and Enabling Formulation Selection for an Insoluble Compound at Preclinical Stage-From In Vitro, In Silico to In Vivo

The objective of this work was to identify an enabling formulation for an insoluble compound ZL006 with potency of boosting leukocytes after chemotherapy. The low oral bioavailability (<1%) of its conventional suspension was the hurdle for the preclinical evaluation via oral administration. Preformulation studies including physical form screening and physicochemical properties determination were performed. Polymorphism was observed, and the more thermodynamically stable form was selected for further studies. ZL006 showed certain supersaturation solubility, although the thermodynamic solubility in FaSSIF was low, which indicated the supersaturating formulation might work. Parameter sensitivity analysis by in silico simulation predicted that in vivo exposure was sensitive to solubility, while particle size reduction would have limited impact on exposure. Based on in silico prediction and the understanding of the molecule from preformulation studies, solid dispersion approach was selected. A preliminary dose escalation pharmacokinetic study in rats demonstrated that in vivo exposure increased in dose-proportional manner from 12.5 mg/kg to 50 mg/kg with around 50% oral bioavailability after oral dosing of the solid dispersion. This work showed that combination of preformulation studies and in silico simulation could efficiently guide the selection of enabling formulation, which could save resources at preclinical stage.

Acupuncture for Symptom Relief in Palliative Care-Study Protocol and Semistandardized Treatment Schemes

The use of complementary and alternative medicine methods such as acupuncture in palliative care has increased over the past years. Well-planned trials are warranted to show its effectiveness in relieving distressing symptoms. The development of treatment schemes to be used in the trial for both acupuncture and medical symptom control is challenging, as both acupuncture and palliative care are highly individualized. Thus, standardized care plans of a randomized controlled trial will have difficulties in producing treatment results that compare to the clinical practice. As an alternative, treatment protocols for both acupuncture and medical symptom control of dyspnea, pruritus, hypersalivation, depression, anxiety, and xerostomia were designed with the input of experts. They are designed to provide sufficient symptom control and comparability for a three-arm, randomized controlled trial. Medical symptom control will be provided to all groups. The two control groups will be medical treatment and sham-laser acupuncture.