Integrative Medicine for Relief of Nausea and Vomiting in the Treatment of Colorectal Cancer Using Oxaliplatin-Based Chemotherapy: A Systematic Review and Meta-Analysis.

The management of chemotherapy-induced nausea and vomiting (CINV) remains an issue in the treatment of colorectal cancer using oxaliplatin-based regimens. Certain traditional plant-based medicines (TMs) have histories of use for nausea and vomiting and have been integrated with conventional therapies for CINV. To assess the effectiveness of integrative management of CINV, meta-analysis was conducted of 27 randomised controlled studies (1843 participants) published from 2005 to 2013. The oxaliplatin plus TM groups showed significantly reduced CINV (risk ratio 0.65 [0.59, 0.71], I(2)  = 28%) compared with oxaliplatin controls, with or without the addition of conventional anti-emetics. Further sensitivity analyses based on the ingredients of the TMs identified six plants (Atractylodes macrocephala, Poria cocos, Coix lacryma-jobi, Astragalus membranaceus, Glycyrrhiza uralensis and Panax ginseng) that were associated with significant reductions in CINV without important heterogeneity. Experimental studies of these six plants have reported inhibitory effects on nausea and vomiting (or its animal equivalent), regulation of gastrointestinal motility, gastroprotective effects and antioxidant actions, which may at least partially explain the effects identified in the meta-analyses of the clinical trial results. These plants warrant further clinical research as potential additions to chemotherapy regimens in patients whose CINV is not sufficiently well controlled by conventional therapies.