Astragalus Formula Reduces Chemo Nerve Pain - Meta-Analysis

meta-analysis PMID: 37820675

Quick Summary: A review of studies found that a traditional Chinese medicine formula containing Astragalus root may help reduce nerve damage caused by a chemotherapy drug called oxaliplatin in colorectal cancer patients. This formula, called Huangqi Guizhi Wuwu Decoction (HGWD), was associated with fewer cases of nerve pain and improved symptoms.

What The Research Found

Researchers looked at several studies to see if a specific herbal formula could help with nerve damage caused by the chemotherapy drug oxaliplatin. The formula, which includes Astragalus root, was found to significantly reduce the chances of developing nerve pain and other nerve-related problems in patients undergoing chemotherapy for colorectal cancer.

Study Details

Who was studied: 1,052 people with colorectal cancer receiving chemotherapy.

How long: The studies varied, but patients took the herbal formula throughout their chemotherapy cycles (typically 2-6 cycles).

What they took: Patients took a traditional Chinese medicine formula called Huangqi Guizhi Wuwu Decoction (HGWD). This formula includes Astragalus root, among other herbs. The amount of Astragalus root in the formula was typically between 9g and 30g per day.

What This Means For You

If you are a colorectal cancer patient undergoing oxaliplatin chemotherapy, this research suggests that a specific herbal formula containing Astragalus root might help reduce nerve pain and other nerve-related side effects. Important: This research is about a specific formula, not just Astragalus root alone. Always talk to your doctor before taking any supplements or herbal remedies, especially during cancer treatment. This formula should only be used under the guidance of a qualified healthcare professional.

Study Limitations

The studies included in the review were mostly conducted in China, so the results may not apply to everyone.

The studies were not always of the highest quality.

The research focused on a combination of herbs, so it's hard to know the exact role of Astragalus root alone.

The long-term effects of the formula were not studied.

Key Findings

This meta-analysis concluded that Huangqi Guizhi Wuwu Decoction (HGWD), where Astragalus membranaceus (Huangqi) is a primary component, significantly reduced the incidence and severity of oxaliplatin-induced peripheral neurotoxicity (OIPN) in colorectal cancer patients compared to control groups (typically常规 supportive care or no specific OIPN treatment). The intervention demonstrated a favorable safety profile with no serious adverse events reported. The authors state HGWD is a "promising option" for OIPN prevention/treatment, though emphasize the need for higher-quality trials.

Study Design

This was a systematic review and meta-analysis of randomized controlled trials (RCTs). It included 14 RCTs involving 1,052 participants diagnosed with colorectal cancer receiving oxaliplatin-based chemotherapy. All studies compared HGWD (administered orally, usually as a decoction) plus conventional care versus conventional care alone (or conventional care plus other non-HGWD interventions). The primary outcome was OIPN incidence (graded per CTCAE or INCI criteria). Secondary outcomes included symptom scores (e.g., numbness, pain) and safety. The analysis followed PRISMA guidelines and used RevMan 5.4 software.

Dosage & Administration

HGWD was administered orally as a decoction. The specific dosage of Astragalus membranaceus (Huangqi) within the formula across the included studies typically ranged from 9g to 30g per daily dose, consistent with standard Traditional Chinese Medicine practice for this formula. The full decoction was usually taken twice daily, starting either before or concurrently with oxaliplatin infusion and continuing throughout the chemotherapy cycles (typically 2-6 cycles).

Results & Efficacy

OIPN Incidence: HGWD significantly reduced the overall incidence of OIPN (Risk Ratio [RR] = 0.42, 95% Confidence Interval [CI]: 0.32 to 0.55; p < 0.00001; I² = 0%). This indicates patients receiving HGWD had a 58% lower relative risk of developing OIPN.
Symptom Severity: HGWD significantly improved symptom scores for key OIPN manifestations like numbness, pain, and cold sensitivity compared to controls. Specific effect sizes varied by study and symptom, but all showed statistically significant improvements (p < 0.05 for most reported comparisons).
Safety: No serious adverse events were attributed to HGWD across the included studies. Minor gastrointestinal discomfort was occasionally reported but was not significantly different from control groups.

Limitations

Major limitations include: 1) High risk of bias in most included RCTs (particularly lack of blinding of participants/personnel and incomplete outcome data), 2) Homogeneous population (all studies conducted in China, limiting generalizability), 3) Variability in control groups (some used "常规 treatment" without strict standardization), 4) Lack of long-term follow-up data on OIPN persistence, 5) Potential publication bias (though funnel plots suggested minimal asymmetry), and 6) Focus on a multi-herb formula, making it impossible to isolate the specific contribution of Astragalus membranaceus alone. Future research requires larger, rigorously designed, multi-center RCTs with standardized protocols and diverse populations.

Clinical Relevance

This analysis suggests HGWD, containing Astragalus membranaceus, may be a valuable adjunctive therapy specifically for colorectal cancer patients undergoing oxaliplatin chemotherapy to reduce the risk and severity of debilitating nerve damage (OIPN). However, it does not support using isolated Astragalus root supplements for general nerve health or OIPN prevention outside this very specific medical context. Patients should never self-treat during chemotherapy; any use of HGWD or similar TCM formulas must be under the strict supervision of an oncologist and a qualified TCM practitioner integrated into the cancer care team due to potential herb-drug interactions and the critical nature of cancer treatment. The findings highlight a potential integrative oncology approach worthy of further high-quality investigation.