Goshajinkigan for prevention of chemotherapy-induced peripheral
neuropathy: a systematic review and meta-analysis
Received: 3 October 2017 / Accepted: 18 December 2017 / Published online: 26 December 2017
Springer-Verlag GmbH Germany, part of Springer Nature 2017
Purpose Chemotherapy-induced peripheral neuropathy (CIPN) limits the dose of chemotherapy and reduces patients’ quality of
life. Goshajinkigan is a Japanese herbal medicine used to alleviate neuropathy and general pain. A clinical guideline for
prevention and management of CIPN stated that the prophylactic efficacy of goshajinkigan against CIPN was inconclusive.
We conducted a systematic review to examine whether goshajinkigan prevents CIPN in patients receiving neurotoxic
Methods We searched PubMed, EMBASE, Ichushi, and the Cochrane Central Register of Controlled Trials for eligible trials.
Randomized controlled trials that examined the efficacy and safety of goshajinkigan for prevention of CIPN were included. Our
primary outcomes were incidence of CIPN, response to chemotherapy, and adverse effects. We pooled data using a random
Results We analyzed five trials involving a total of 397 patients. When evaluated with Neurotoxicity Criteria of Debiopharm,
goshajinkigan was associated with reduced incidence of CIPN of grade ≥ 1 (risk ratio [RR] 0.43; 95% CI, 0.27 to 0.66) and grade
3 (RR 0.42; 95% CI, 0.25 to 0.71), but this beneficial association was not found for grade ≥ 2 of CIPN. Goshajinkigan was not
associated with reduced incidence of CIPN when assessed with the National Cancer Institute Common Terminology Criteria for
Adverse Events, or improved response to chemotherapy. Goshajinkigan was well tolerated based on one trial.
Conclusions Goshajinkigan is unlikely to prevent CIPN in patients undergoing neurotoxic chemotherapy. Given the low quality
and insufficient amount of the evidence, use of goshajinkigan as standard of care is not currently recommended.
Keywords Chemotherapy-induced peripheral neuropathy
Chemotherapy-induced peripheral neuropathy (CIPN) is a
common treatment-related adverse effect. The prevalence of
CIPN varies according to the type of chemotherapy, but is gen-
erally estimated to be 68 and 30% in the short and long term,
respectively . CIPN limits physical function and functional
quality of life in cancer patients, leading to dose limiting of
chemotherapy . The economic impact of CIPN is also sub-
stantial, because CIPN leads to excess healthcare costs and
resource use in addition to the impact of cancer treatment
. Given the negative influence of CIPN on every aspect of
the lives of cancer patients, prevention of CIPN is needed.
Goshajinkigan, which is a Japanese herbal medicine em-
pirically used to treat CIPN , is a mixture of extracts from
ten raw botanical materials in fixed proportions  and has
been used in Japan to treat diabetic neuropathy [33, 36], over-
active bladder , and non-specific pain and numbness. A
modest-sized, randomized trial in ovarian or endometrial can-
cer  and two observational studies in colorectal cancer [19,
37] suggest potential benefit of goshajinkigan for mitigation
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s00520-017-4028-6) contains supplementary
material, which is available to authorized users.
* Akira Kuriyama
Department of General Medicine, Emergency and Critical Care
Center, Kurashiki Central Hospital, 1-1-1 Miwa Kurashiki,
Okayama 710-8602, Japan
Department of General Internal Medicine, Tottori Prefectural Central
Hospital, 730 Ezu Tottori, Tottori 680-0901, Japan
Supportive Care in Cancer (2018) 26:1051–1059