Abstract
Dear Editor,
It was of great interest to read the overview by Wu et al 1 evaluating the efficacy and safety of Shenyi Capsule (SC, Ginsenoside Rg3) as adjuvant cancer therapy through 13 systematic reviews/meta-analyses (SRs/MAs). This work makes a pivotal contribution by comprehensively assessing methodological quality and evidence reliability via AMSTAR-2, PRISMA 2020, ROBIS, and GRADE tools, highlighting critical flaws in existing research while confirming SC’s potential in enhancing efficacy and reducing adverse effects. However, key gaps merit concise discussion to strengthen its clinical and research implications.
First, heterogeneous cancer types and treatment regimens lack stratified analysis. The overview notes most studies focused on lung cancer, with sparse data on other cancers (eg, breast, liver cancer). 2 Moreover, interventions mixed chemotherapy, radiotherapy, and targeted therapy without stratification, yet Shea et al 3 emphasize that unaddressed heterogeneity can obscure true treatment effects. This limits conclusions on SC’s applicability across different cancer types and treatment combinations, a critical need for clinical decision-making.
Second, methodological flaws’ root causes and targeted solutions are underexplored. The overview documents unregistered protocols, incomplete searches, and opaque funding disclosure, but fails to analyze why these issues persist in TCM-related SRs/MAs (eg, inadequate methodological training, insufficient emphasis on transparency). Whiting et al 4 argue that addressing bias requires not just identifying flaws but addressing their origins, yet the overview provides no tailored recommendations for TCM research, delaying methodogical improvement.
Third, TCM-specific factors are overlooked. As a Class I TCM anticancer drug, SC’s efficacy may be influenced by dosage, treatment course, and syndrome differentiation (a core TCM principle). However, existing SRs/MAs lack unified definitions of these factors, and the overview does not discuss their impact on results. Liu et al 2 note that ignoring TCM-specific variables limits the clinical applicability of evidence, as clinicians cannot determine optimal regimens for individual patients.
In conclusion, Wu et al’s overview lays a solid foundation for understanding SC’s evidence landscape. Addressing heterogeneity through stratified analysis, exploring methodological flaws’ roots, and integrating TCM-specific factors will be critical to improving evidence quality. Future research incorporating these elements will better support SC’s rational use in clinical practice.
