Intrathoracic infusion therapy with Lentinan and chemical irritants for malignant pleural effusion: a systematic review and meta-analysis of 65 randomized controlled trials

• Published in: Phytomedicine (Stuttgart) 2020-09, Vol.76, p.153260-153260, Article 153260
• Main Authors: Xiao, Zheng, Jiang, Yuan, Chen, Xiao-Fan, Wang, Cheng-Qiong, Zheng, Xiao-Tian, Xu, Wei-hong, Zou, Xing-Xia, Zhou, Jia-Mei, Yang, Ya-Hui, Hu, Shan-Shan, Shan, Li-Jing, Cai, Qing-Yong, Tang, Yu-Hong, Feng, Ji-Hong, Xiao, Xue
• Format: Article
• Language: English
• Subjects: Chemical irritants; Intrathoracic infusion; Lentinan; Malignant pleural effusion (MPE); Meta-analysis; Systematic review
• ISSN: 0944-7113; 1618-095X
• DOI: 10.1016/j.phymed.2020.153260

•Meta-analysis involving 65 randomized controlled trials containing 4,080 patients.•Lentinan with DDP may be an optimal combination with chemical irritants.•The moderate to large, KPS score ≥50-60, AST ≥3m may be therapeutic threshold.•Treatment with 3-4mg/time, one time/week for 3-4 times may be optimal usage.•Lentinan may show a synergistic effect for DDP, and decrease its dosage. Aderivative of Shiitake mushrooms, Lentinan is used to control malignant pleural effusion (MPE) through intrathoracic infusion. To determine the clinical response, survival and safety of Lentinan plus chemical irritants, and the optimal combinations with chemical irritants, indication, threshold and optimal regimen for achieving the desired responses. We performed a new systematic review and meta-analysis following the PRISMA guidelines. We collected all randomized controlled trials (RCTs) regarding Lentinan plus chemical irritants from Chinese and English electronic databases (from inception until March 2019). We evaluated their bias risk, synthesized data using meta-analysis, and summarized evidence quality following the Grades of Recommendation Assessment, Development and Evaluation approach. We included 65 RCTs involving 4,080 patients and nine chemical irritants. Most trials had unclear bias risk. Lentinan with cisplatin significantly improved complete response [Risk ratio (RR) = 1.68, 95% confidence intervals (CI) (1.51 to 1.87), p < 0.00001, Fig.3a] and quality of life [RR = 1.51 95% CI (1.41 to 1.62), p < 0.00001, Fig.4], and decreased the risk of treatment failure, myelosuppression, gastrointestinal reaction, and chest pain. For patients with moderate to large volume of the pleural effusion, primary treatment, KPS score ≥ 50–60, or anticipated survival time ≥ 3months, Lentinan (3–4 mg/time, once a week for three to four times) withcisplatin (30–40 mg/m2 or 50–60 mg/m2) significantly improved complete response and decreased failure. Most results were robust and moderate quality. The results suggest that Lentinan with chemical irritants, especially cisplatin is beneficial to the patient with MPE, and provide evidence for the indication, threshold, and optimal regimen that may achieve success and decrease failure. [Display omitted]