Chinese herbal medicine for pancreatic cancer

Chinese herbal medicine has been claimed by TCM practitioners to be able to improve survival and relieve pain and symptoms in pancreatic cancer patients. A total of 53 clinical studies investigate herbal therapy for pancreatic cancer, including 20 RCTs 6-25 and 4 non-randomized studies 26-29. There are no study reports on other TCM modalities such as dietary therapy, acupuncture, qigong, or massage available for this CAM summary.

Controlled clinical trials

Twenty-four clinical trials (Table 1) including 20 RCTs and 4 non-randomized trials are available. The 20 RCTs including 1145 mid/advanced stage pancreatic cancer patients tested different herbal medicines with or without chemotherapy. The 4 non-randomized studies involving 204 mid/advanced stage pancreatic cancer patients compared Chinese herbal products plus chemo/radiotherapy with chemo/radiotherapy alone.

In general, the randomised and non-randomised clinical studies, which were all conducted and published in China, showed significant benefits from the combination of Chinese herbal medicine with chemotherapy in terms of complete and/or partial remission, improvement of immunity function, improved quality of life, pain relief, and survival.

The outcomes reported in the included studies differed substantially. Although the number of clinical studies increased over time and a variety of positive clinical outcomes were reported, there was no solid evidence for a relative benefit of Chinese herbal medicine alone over chemotherapy. Risk of bias in these studies is high due to small sample sizes, and methodological flaws (randomization and blinding, intention-to-treat analysis, and attrition).

According to an empirical study by Vickers et al. 33, almost all Chinese acupuncture trials published in Chinese report positive results, and publication bias might be the major explanation. Since the studies in this summary were conducted and published in Chinese literature, the positive findings need to be interpreted with caution.

Pre-clinical studies

An in vitro study on two Chinese herbal formulations in pancreatic cancer cell lines showed a growth inhibition effect 32.

As the active ingredients of the herbal preparations are largely undefined, the biologic mechanisms of the potential effect have not been clearly elucidated.