To analyze the clinical characteristics of cancer related anemia (CRA) in older cancer patients undergoing multi-line anti-tumor treatment.

A cross-sectional study was conducted, including patients with CRA who were ≥65 years old and had received or were currently undergoing multi-line treatment at 9 hospitals in Beijing from June 1, 2018 to September 30, 2023. Data on gender, age, past history, family history, tumor type, metastasis site, clinical symptoms, blood routine, specialized examination for anemia, anti-tumor and anemia correction treatment were collected. The basic characteristics of the included patients, clinical symptoms, the status of blood cell reduction, treatment conditions, and the distribution of traditional Chinese medicine (TCM) syndrome characteristics were analyzed.

A total of 602 patients were included. The tumor types included lung cancer, colorectal cancer, gastric cancer, esophageal cancer, breast cancer, gynecological tumors, lymphoma. The overall median hemoglobin (HGB) level was 99.00 (88.00, 107.00) g/L. The HGB levels of patients with different tumor types showed significant differences (P < 0.001). The HGB levels of patients with gynecological tumors were significantly lower than those of patients with colorectal cancer, lung cancer and esophageal cancer (P < 0.05). The most common clinical symptoms were fatigue, loss of appetite, irregular bowel movements and pain. In terms of anti-tumor treatment, 405 patients were receiving multi-line anti-tumor treatment (including combined chemotherapy, combined radiotherapy, combined targeted therapy, and combined immunotherapy), 197 patients were receiving symptomatic supportive treatment after multi-line anti-tumor treatment. In terms of anemia correction treatment, 183 patients received erythropoietin, folic acid, iron, vitamin B₁₂, or blood transfusion, while 293 patients received TCM for correcting anemia (including Chinese patent medicines, Chinese herbal decoctions, combinations of Chinese patent medicines and Chinese herbal decoctions). Specialized tests for anemia, such as serum iron, total iron binding capacity, transferrin saturation, transferrin, erythropoietin et al, have a detection rate of only 3.65%~27.91%. In terms of the characteristics of TCM syndromes, the main TCM syndrome types of the patients were as follows: syndrome of spleen-stomach weakness, syndrome of qi and blood deficiency, syndrome of heart-spleen deficiency, syndrome of spleen-kidney yang deficiency, syndrome of liver and kidney yin deficiency. Some patients also have the accompanying symptoms of internal binding of static blood and poison, phlegm dampness retention. Further comparison revealed that the HGB level of older patients with CRA who had syndrome of spleen-stomach weakness was significantly lower than patients with other symptom types (P < 0.001). The HGB level of patients with syndrome of qi and blood deficiency was significantly lower than patients with syndrome of spleen-kidney yang deficiency (P < 0.01) and syndrome of liver and kidney yin deficiency (P < 0.001). Patients with symptoms of internal binding of static blood and poison, or symptoms of phlegm dampness retention had significantly lower HGB levels compared to those without accompanying symptoms (P < 0.01).

The rate of specialized blood test for anemia in older patients with CRA was relatively low. The most common TCM syndrome types were syndrome of spleen-stomach weakness and syndrome of qi and blood deficiency. The overall treatment rate was also low. The screening, specialized diagnosis and monitoring of older patients with CRA need to be given more attention, and treatment methods such as TCM, Western medicine, and integrated TCM-Western medicine should be selected based on the patient’s condition.

Objective To investigate the mechanism by which epigallocatechin gallate (EGCG) induces macrophage polarisation via the stimulator of interferon genes (STING) signalling pathway.

A Lewis lung carcinoma transplanted tumor mouse model was established using SPF-grade 6-8-week-old male C57BL/6 mice. Twenty-four successfully established mice were randomly assigned using a random number table to the control group, EGCG group, and cisplatin (DDP) group, with eight mice per group. Administration commenced when subcutaneous tumor volume reached approximately 80 mm³. The EGCG group received intraperitoneal injections of 50 mg/kg EGCG solution daily; the DDP group received 2 mg/kg DDP solution intraperitoneally three times weekly; the control group received intraperitoneal injections of saline solution of identical formulation and volume daily. Treatment continued for 14 consecutive days. General condition and body weight changes were monitored, alongside tumor volume alterations and tumor suppression rates across groups. Hematoxylin-eosin staining was used to examine cardiac, hepatic, and renal alterations in each group. Flow cytometry assessed the expression of marker molecules and the proportion of immune cells reflecting classical activated (M1) versus alternative activated (M2) macrophage polarisation in tumor-associated macrophages (TAMs) within tumor tissues. Immunofluorescence was employed to detect changes in tumor-associated macrophage phenotypes within tumor tissues, whilst Western blotting assessed STING signalling pathway protein expression.

No significant changes in body weight were observed across groups during the treatment period. Compared to the control group, both the EGCG and DDP groups significantly inhibited tumor growth in mice (P < 0.01), with favourable safety profiles in major organs. Flow cytometry revealed that, relative to the control group, the EGCG group exhibited a reduced proportion of cells positive for CD206, a characteristic surface marker of M2 macrophages (P < 0.01), while expression of CD86, a specific marker for M1 TAMs, was elevated (P < 0. 05). The DDP group also demonstrated a reduced proportion of CD206-positive cells (P < 0. 05). Changes in the immune microenvironment: Compared with the control group, the EGCG group exhibited increased infiltration of CD8⁺ T cells and dendritic cells (DCs) in tumor tissue (P < 0. 05), alongside reduced proportions of regulatory T cells (Tregs) and myeloid-derived suppressor cells (MDSCs) (P < 0. 05). The DDP group demonstrated increased DC proportion and reduced Treg and MDSC proportions (P < 0. 05). Immunofluorescence analysis revealed reduced CD206 expression and increased CD86 expression in both the EGCG and DDP groups compared with the control group (P < 0. 05, P < 0.01); Western blot analysis revealed that, compared with the control group, the EGCG group exhibited increased protein expression of STING, TANK-binding kinase 1 (TBK1), phosphorylated TBK1, interferon-regulated factor 3 (IRF3), and phosphorylated IRF3 (P < 0. 05, P < 0.01), while the DDP group showed increased STING protein expression (P<0. 05).

EGCG promotes the polarisation of TAMs from M2 to M1 type by activating the STING signalling pathway, thereby remodelling the immunosuppressive microenvironment in non-small cell lung cancer and enhancing the anti-tumor immune response.

We aimed to evaluate the efficacy and safety of Shengxuebao Mixture in the treatment of cancer-related anemia (CRA) presenting with syndrome of deficiency of liver and kidney combined with syndrome of deficiency of both qi and blood.

A randomized, double-blind, placebo-controlled, multicenter clinical trial was conducted. Eligible patients with malignant tumors meeting the inclusion and exclusion criteria were enrolled from 26 hospitals, including Dongzhimen Hospital, Beijing University of Chinese Medicine, Xiaogan Central Hospital, and Yangzhou Hospital of Traditional Chinese Medicine, from June 1, 2022, to September 30, 2024. Patients were allocated 1:1 to either the experimental group receiving Shengxuebao Mixture or the control group receiving its simulator (placebo) using a block randomization method under double-blind conditions. Both groups received 15 mL orally three times daily for 28 consecutive days. The primary efficacy indicators included the hemoglobin (Hb) improvement rate (R_Hb) and the traditional Chinese medicine (TCM) syndrome improvement rate (R_TCM) at week 4 of treatment. The secondary efficacy indicators encompassed Hb and red blood cell (RBC) count, Karnofsky Performance Status (KPS) score, TCM syndrome score, individual TCM symptom scores, and changes in each of these indicators compared to the baseline period at weeks 2, 4, and 6 of treatment. Safety evaluations were conducted at week 4 of treatment.

A total of 239 patients were enrolled, with 225 cases included in the Full Analysis Set (FAS) (109 in the experimental group vs. 116 control group), 163 in the Per Protocol Set (PPS) (77 vs. 86), and 225 in the Safety Set (SS) (109 vs. 116). Baseline characteristics between groups showed no significant differences. Significant differences were observed between the experimental and control groups in R_Hb at week 4 (FAS: 49.51% vs. 35.24%, P < 0.05; PPS: 53.25% vs. 36.05%, P < 0.05) and R_TCM at week 4 (FAS: 61.54% vs. 39.62%, P < 0.01; PPS: 64.94% vs. 40.70%, P < 0.01). At weeks 2, 4, and 6, the experimental group showed greater improvements in Hb and RBC counts than the control group. Additionally, the TCM syndrome scores were lower in the experimental group than in the control group at these time points. Except for week 2 in PPS, the KPS improvement was better in the experimental group than in the control group (P < 0.05). The experimental group also demonstrated a greater reduction in scores for individual TCM symptoms such as spiritlessness and weakness, poor appetite and reduced food intake at weeks 4 and 6 compared to the control group (P < 0.05, P < 0.01). Furthermore, the reduction in vertigo score was more pronounced in the experimental group at week 6 (P < 0.01). For the score of pale and lusterless complexion, only in the PPS was the reduction from baseline more significant in the experimental group than in the control group at weeks 4 and 6 (P < 0.05). No significant differences were observed between the experimental and control groups in the incidence of all adverse events or drug-related adverse reactions.

Shengxuebao Mixture demonstrates significant efficacy in patients with CRA presenting syndrome of deficiency of liver and kidney combined with syndrome of deficiency of both qi and blood, effectively increasing Hb levels, ameliorating TCM syndromes, alleviating clinical symptoms, and enhancing functional status, with no significant difference in adverse drug reactions compared to the placebo.

To evaluate the effectiveness and safety of seven oral Chinese patent medicines (CPMs) as adjuvant therapy for cancer-related anemia (CRA) by network meta-analysis (NMA).

A literature search to obtain randomized controlled trials (RCTs) of seven oral CPMs in the adjuvant treatment of CRA was conducted in multiple databases from the inception to April 2022. The RevMan5.3 and R 4.1.1 software were used for NMA.

We ultimately included 29 RCTs with 2140 patients. Traditional meta-analysis showed that Fufang E'jiao syrup (FFEJS), Shengxuebao mixture (SXBM), Shengxuening tablets (SXNT), Jianpi Shengxue granules (JPSXG), and Yixuesheng capsule (YXSC) combined with basic Western treatment (BWT) could improve the hemoglobin (HGB) level. JPSXG combined with BWT could improve the red blood cell (RBC). FFEJS combined with BWT improved the Karnofsky performance status (KPS). NMA showed that FFEJS, JPSXG, SXBM, and SXNT plus BWT improved HGB better than Shengxue tablets (SXT) plus BWT, with top three ranking results being JPSXG plus BWT > SXNT plus BWT > FFEJS plus BWT. FFEJS plus BWT, JPSXG plus BWT, SXBM plus BWT, SXNT plus BWT, and SXT plus BWT improved RBC better than BWT, with top three ranking results being SXNT plus BWT > JPSXG plus BWT > FFEJS plus BWT. In terms of the KPS score, compared with SXT plus BWT, FFEJS, JPSXG, SXBM, SXNT, and Yizhong Shengxue capsule (YZSXC) plus BWT had higher KPS, with top three ranking results being SXBM plus BWT > JPSXG plus BWT > FFEJS plus BWT.

Our NMA demonstrated that seven oral CPMs used as adjuvant treatment of CRA had a definite clinical effect. JPSXG not only increases the levels of HGB and RBC to enhance the clinical effect but also improves patients' quality of life. More accurate conclusions need to be verified by more high-quality RCTs.

To explore the hemostatic mechanism of Jianpi Yiqi Shexue decoction (JYSD) by regulating vascular factors in an immune thrombocytopenia (ITP) mouse model.

An ITP mouse model was established by the passive-immune modeling method, and interventional drugs used were prednisone tablets and JYSD. The platelet count; vascular activity–related factors vWF, VCAM-1, and TM; and VEGF and bFGF were used as observational indicators.

On the 8th day of administration, compared with the model group, platelet counts in the prednisone and JYSD groups increased (both P < .001). Compared with the control group, the levels of vWF, VCAM-1, and TM in the other groups were lower (all P < .05). The VCAM-1 level in the JYSD group was higher than that in the prednisone group (P = .012), but without significant difference compared with the model group (P = .051). The TM level in the JYSD group was the lowest (vs. the model group, P = .047; vs. the prednisone group, P = .006). Compared with the control group, the IOD values of VEGF and bFGF in the other three groups were lower (all P < .01). The IOD values of VEGF in the prednisone and JYSD groups were both higher than those in the model group (P = .002 and P < .001, respectively). The IOD values of bFGF among the model, prednisone, and JYSD groups were not statistically significant (P > .05).

A vascular factor disorder is involved in the pathogenesis of ITP. JYSD can increase the platelet count, upregulate VEGF expression, and reduce the TM level. JYSD has the same effect as prednisone tablets in regulating platelet, vWF, VEGF, and bFGF, with a stronger effect in normalizing VCAM-1 and TM levels. The hemostatic mechanism of JYSD is closely related to the effective balance of vascular factors.

To investigate the anti-angiogenic effect of tea polyphenols (TP_S) on breast cancer and normal tissues in a mouse model.

Breast cancer was successfully implanted into 48 BALB/c mice, which were then randomly divided into a TP oral gavage group, a TP local injection group, a ginsenoside Rg3 group, and a model control group according to a random number table. The tumor inhibitory rates of each group were calculated, while microvessel density (MVD) and the expression of vascular endothelial growth factor (VEGF), basic fibroblast growth factor (bFGF), and tissue inhibitor of metalloproteinase (TIMP-2) were detected by immunohistochemistry.

TPs could inhibit the growth of breast cancer xenografts in the mouse model. The tumor inhibition rates of the TP oral gavage and TP local injection groups were 37.43% and 40.94%, respectively. Compared with the model control group, MVD and VEGF and bFGF expression was downregulated (all P < .05), whereas TIMP-2 expression was elevated in the TP oral gavage and TP local injection groups (P = .015 and P = .032). TPs showed no significant effect on MVD and VEGF and TIMP-2 expression in the heart, brain, and kidney of the mouse model.

TPs can restrict the growth of breast cancer by specifically inhibiting the angiogenesis of breast tumor tissue while having little effect on the normal tissue of important organs including the heart, brain, and kidney.

To investigate the anti-cancer effects and mechanism of modified Liangfu granule (MLFG) in BGC-823 gastric cancer cells.

The drug serum was extracted from abdominal aorta of Wistar rats treated by cyclophosphamide, dioscin, MLFG (high-, medium-, and low-dose), respectively. MTS assay was performed to detect the effect of different concentrations of MLFG and dioscin on cell growth. The effect of MLFG on cellular apoptosis was detected by flow cytometry. Western blot was used to examine Bcl-2 and Akt in BGC-823 cells treated with MLFG. Quantitative real-time polymerase chain reaction assay was performed to determine the expression level of caspase-3, E2F1 and E2F3 genes in cells treated by MLFG- and dioscin-containing serum.

MLFG- and dioscin-containing serum inhibited the cell proliferation of BGC-823 cells. MLFG induced gastric carcinoma cell apoptosis and inhibited the expression of Bcl-2 and Akt in a dose-dependent manner. MLFG also significantly induced the gene expression of caspase-3 and downregulated E2F1 and E2F3 gene expression.

The effect of MLFG and dioscin on inhibiting cell proliferation and induction of apoptosis of gastric cancer cells might be related to the regulation of Bcl-2 and Akt proteins and the expression of caspase-3, E2F1 and E2F3 genes.