Meta-analysis and network pharmacology-based investigation of Shenqi Fuzheng injection plus docetaxel for the efficacy and molecular mechanism of breast cancer

Introduction: Breast cancer (BC), known as the "pink killer," with a high incidence and poor prognosis, is one of the most prevalent malignant tumors in women. Shenqui Fuzheng injectin (SFI), a kind of Chinese medicine immunomodulator, has the potential to enhance efficacy and reduce toxicity in treating BC in combination with docetaxel (DOC) because of its pharmacological effects of tonifying Qi and strengthening body resistance. Hence, there is an urgent need to summarize the effects of SFI plus DOC on various outcomes in BC patients, and to elucidate the molecular mechanisms of SFI plus DOC anti-BC. Methods: Studies matching this topic were identified by searching PubMed, Embase, the Cochrane Library, CNKI, CBM, VIP, and the Wanfang database, and screened according to inclusion and exclusion criteria. Two researchers evaluated the methodological quality of the studies using the Cochrane bias risk assessment tool. Review Manager 5.4 and Stata 17.0 were used to conduct the meta-analysis of the extracted data. Network pharmacology and molecular docking were conducted to investigate the potential mechanism of SFI combined with DOC in treating BC. Results: Overall, 11 studies involving 1280 participants were included. Meta-analysis revealed that SFI plus DOC was beneficial for increasing the objective response rate [RR=1.32, 95 %CI (1.14, 1.51)], improving immune capacity [MD=2.15, 95 %CI (1.41, 2.89)], decreasing tumor marker levels [MD=-11.08, 95 %CI (-13.00, -9.16)], and reducing the incidence of adverse reactions [RR=0.57, 95 %CI (0.47, 0.69)]. Network pharmacology revealed that the 3 most active ingredients were luteolin, quercetin, and kaempferol. The core target genes were ERBB2, EGFR, PIK3CG, GSTP1, TOP2A, and HIF1A. The relevant pathways were the PI3K-AKT signaling pathway and the HIF-1 signaling pathway. Molecular docking showed that the core active ingredients combined well with potential targets. Conclusion: SFI plus DOC can achieve better therapeutic effects than DOC alone in treating BC. Moreover, SFI combined with DOC may treat BC through a multitarget and multipathway network. Further pharmacological experiments are needed to validate the potential mechanism of SFI combined with DOC in treating BC.