Inoperable stage IV gastric cancer: how much longer is survival when herbal medicine is added to chemotherapy? — A clinical analysis of 182 integrative-care patients

Even in gastric cancer that cannot be operated on, herbal medicine can be beneficial. Today we summarize this topic head-on through a single clinical analysis from Changzheng Hospital in Shanghai, China.

To state the conclusion first: even in patients with inoperable stage IV gastric cancer, those who added herbal medicine to standard chemotherapy lived longer than those who did not, and they also better preserved their functional capacity and quality of life.

Inoperable stage IV gastric cancer: how much longer do patients live when herbal medicine is added to standard chemotherapy?

Gastric cancer is a cancer with high incidence and mortality worldwide, and a considerable proportion is found at an advanced stage where surgery is difficult. In such cases, standard chemotherapy is the main intervention, but the median survival of stage IV gastric cancer usually remains at 9–11 months.

This study, published in 2017 in the international journal Journal of Integrative Medicine, retrospectively analyzed 182 patients with inoperable stage IV gastric cancer who were admitted to Changzheng Hospital in Shanghai between 2005 and 2015. Of these, 88 patients formed the herbal integrative-care group, who added herbal medicine to standard chemotherapy for at least three months, while 94 patients formed the chemotherapy-alone group, who received only chemotherapy. The two groups showed no statistically significant differences in age, sex, smoking, drinking, tumor characteristics, and so on.

As a result, the median survival (overall survival, OS) of the herbal integrative-care group was 16.9 months (95% confidence interval 14.68–19.12), more than six months longer than the 10.5 months (95% confidence interval 9.74–11.26) of the chemotherapy-alone group. The fact that this result came from stage IV gastric cancer, which has a poor prognosis, feels especially meaningful.

How did the 1-, 3-, and 5-year survival rates differ?

As time went on, the gap between the two groups widened further. The survival rates of the herbal integrative-care group versus the chemotherapy-alone group were 70% versus 32% at 1 year, 18% versus 4% at 3 years, and 11% versus 0% at 5 years (difference between the two groups P<0.001).

The contrast at the 5-year mark is especially striking. Whereas no patient in the chemotherapy-alone group survived to 5 years, in the herbal integrative-care group a little more than one in ten passed the 5-year mark.

Is living longer everything — what happened to quality of life?

This study looked not only at survival but also at patients' functional capacity. The measure was the Karnofsky performance status (KPS), which rates daily living and overall condition from 0 to 100, where a higher score means a better condition.

Before treatment began, the two groups' scores were essentially the same at 72.27 and 71.28 (no difference). But six months later, the herbal integrative-care group had actually risen to 75.00 points, while the chemotherapy-alone group fell markedly to 60.64 points (P<0.001). That the group given herbal medicine alongside continuing chemotherapy showed better functional capacity is very telling.

In a multivariate analysis adjusting for several factors together (Cox regression), adding herbal medicine was also confirmed to be an independent protective factor working in favor of survival (hazard ratio 0.376, 95% confidence interval 0.259–0.548).

What kind of herbal medicine was it?

The herbal medicine used in this study was not a single fixed prescription, but an individualized treatment tailored to each patient's symptoms and physical condition — that is, treatment based on pattern differentiation (byeonjeung, 辨證). It can be summarized in two main effects: first, promoting the elimination of waste products in the body to create an environment in which the tumor finds it hard to grow, and second, restoring the body's immune function.

What is noteworthy is that it was not a matter of applying "the same prescription for everyone" across the board, but of thoughtfully coordinating "an individually tailored prescription for each patient." "Personalized prescription" — this is where the strength of Korean medicine lies.

Is herbal medicine instead of chemotherapy, or together with it?

It must be "together." All the benefits in this study came from the effect when herbal treatment was "added" while standard chemotherapy was maintained. Herbal medicine should be understood not as replacing standard treatments such as surgery, chemotherapy, and radiation, but as further strengthening their effects.

Even though this study is a retrospective, single-institution analysis, it is worth noting that in stage IV gastric cancer, which has a poor prognosis, survival, survival rates, and quality of life were consistently better in the herbal integrative-care group.

If you are receiving, or about to receive, chemotherapy for gastric cancer that is difficult to operate on, we recommend faithfully continuing your standard treatment while consulting thoroughly with a specialist Korean-medicine doctor to add a herbal prescription suited to you.