Comparative efficacy and safety of traditional Chinese medicine injections combined with chemotherapy for advanced non-small cell lung cancer: a Bayesian network meta-analysis.

Non-small cell lung cancer (NSCLC) remains a leading cause of cancer-related mortality worldwide. Although chemotherapy is an important treatment strategy for advanced NSCLC, its efficacy is limited by treatment resistance and adverse events. Traditional Chinese medicine injections (TCMIs) are widely used as adjunctive therapies; however, the comparative efficacy and safety of different TCMI-based regimens remain unclear. This study aimed to compare the efficacy and safety of various TCMIs combined with chemotherapy using Bayesian network meta-analysis. RCTs on TCMIs combined with chemotherapy for NSCLC were retrieved from Chinese databases including CNKI, Wanfang, VIP, and Chinese Biomedical Literature Database, as well as English databases including PubMed, Web of Science, and Cochrane Library. The retrieval period was from January 1, 2021 to May 1, 2026. The Cochrane risk-of-bias tool was used to assess the methodological quality of the included studies, and the certainty of network evidence was evaluated using the Confidence in Network Meta-Analysis (CINeMA) framework. Stata and R software were used to perform network meta-analysis. A total of 71 RCTs involving 6,386 patients were included. The results of the network meta-analysis showed that Kanglaite Injection combined with chemotherapy showed a relatively favorable ranking for objective response rate (ORR), CD8, and skin adverse reactions; Kang'ai Injection combined with chemotherapy for hemoglobin reduction-related adverse reactions; Shenqi Fuzheng Injection for natural killer cells (NK cells), immunoglobulin G (IgG), neuron-specific enolase (NSE), and carbohydrate antigen 19-9 (CA19-9); Aidi Injection for immunoglobulin A (IgA), immunoglobulin M (IgM), and bone marrow suppression-related adverse reactions; Fufang Kushen Injection for carcinoembryonic antigen (CEA), vascular endothelial growth factor (VEGF), and adverse reactions such as leukopenia, liver and kidney function damage, and gastrointestinal symptoms; Shenmai Injection combined with chemotherapy for carbohydrate antigen 125 (CA125); Yadanzi Youru injection combined with chemotherapy for squamous cell carcinoma antigen (SCC); Xiao'aiping Injection for cluster of differentiation 4 positive T lymphocyte (CD4+ T Cell)/cluster of differentiation 8 positive T lymphocyte (CD8+ T Cell); Renshen duotang injection for disease control rate (DCR), cluster of differentiation 3 positive T lymphocyte (CD3+ T Cell), cluster of differentiation 4 positive T lymphocyte (CD4+ T Cell), and cytokeratin 19 fragment (CYFRA21-1); Huangqi Duotang injection combined with chemotherapy for thrombocytopenia-related adverse reactions. Meta-regression analyses identified statistical associations between age and effect estimates of CYFRA21-1, SCC, VEGF, and IgM; however, these findings should be interpreted as exploratory associations rather than causal explanations. Subgroup analysis of CYFRA21-1 suggested potential differences across age-related subgroups, which require further validation. TCMIs combined with chemotherapy maybe associated with improvements in clinical response, immune-related indicators, tumor-associated markers, and treatment tolerability in patients with advanced NSCLC. However,given the limited certainty of evidence, substantial heterogeneity, and methodological limitations of included studies, these findings should be interpreted cautiously and require confirmation through high-quality prospectivestudies. https://www.crd.york.ac.uk/PROSPERO/, identifier CRD420261392216.