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Thymosin alpha1 plus chemotherapy improves response rates and immune markers in gastric cancerThymosin alpha1 combined with chemotherapy shows promise for gastric cancer

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Key Takeaway
Note that thymosin alpha1 plus chemotherapy may improve short-term response and safety in gastric cancer.

This meta-analysis evaluates the efficacy and safety of thymosin alpha1 combined with chemotherapy compared to chemotherapy alone in patients with gastric cancer. The analysis included 1,704 patients and reported several improvements in short-term outcomes, including a higher objective response rate (RR = 1.39) and higher disease control rate (RR = 1.16). Additionally, patients receiving the combination therapy showed higher KPS scores (WMD = 8.27) and improved immune markers, including CD3+ (WMD = 7.73), CD4+ (WMD = 6.87), and NK cells (WMD = 4.73).

Regarding safety, the combination therapy was associated with a lower risk of gastrointestinal reactions (RR = 0.63), myelosuppression (RR = 0.60), abnormal liver function (RR = 0.54), and neurotoxicity (RR = 0.47). However, the authors note that the certainty of evidence is low because the included studies were all small-sample studies conducted in China and the methodological quality was limited.

Clinical application is limited by the fact that the included trials did not systematically report long-term survival outcomes. While the combination therapy is associated with improved short-term efficacy and immune function, long-term benefits for patients with gastric cancer remain unclear.

How this fits prior evidence

This meta-analysis addresses a gap in the management of gastric cancer by evaluating thymosin alpha1 as an adjunct to chemotherapy. While previous evidence has focused on surgical recovery via Electrical Acupoint Stimulation and the risks associated with autoimmune gastritis and pernicious anemia, this study specifically addresses the role of immune-modulating agents in improving short-term response rates and safety profiles in gastric cancer patients.

A meta-analysis looked at 1,704 patients with gastric cancer to see how thymosin alpha1 works when combined with chemotherapy. The study compared this combination to chemotherapy alone. The researchers found that patients receiving the combination therapy showed higher overall response rates and better disease control. They also noted improvements in quality of life scores and several markers of immune system activity.

While the combination showed positive results in the short term, there are important reasons to be cautious. The evidence is considered low certainty because the included studies were all small and conducted in one country. Additionally, the studies did not provide data on long-term survival.

Patients should view these findings as an early indication of potential benefits rather than a proven long-term cure. Because the data is limited and the quality of the evidence is low, it is important to discuss these results with a doctor to understand how they might apply to a specific treatment plan.

What this means for you:
Thymosin alpha1 may improve short-term results and immune function, but evidence for long-term survival is limited.

Common questions

What are the benefits of adding thymosin alpha1 to chemotherapy?

The study found that combining thymosin alpha1 with chemotherapy was associated with higher overall response rates and better disease control. It also showed higher scores for quality of life and improved immune markers, such as increased NK cells and CD4+ cells, compared to chemotherapy alone.

Is this treatment safe for gastric cancer patients?

The study reported that the combination therapy was associated with a lower risk of certain side effects compared to chemotherapy alone. These included fewer gastrointestinal reactions, less myelosuppression, and a lower incidence of abnormal liver function and neurotoxicity.

Is this a proven long-term treatment for gastric cancer?

The evidence is currently limited. The study was based on small trials that did not report long-term survival outcomes. Because the quality of evidence is low, these results show a link to improved short-term efficacy rather than a proven long-term cure.

Study Details

Study typeMeta analysis
EvidenceLevel 1
PublishedSep 2026
View Original Abstract ↓
ObjectiveTo systematically evaluate the efficacy and safety of thymosin α1 combined with chemotherapy in the treatment of gastric cancer.MethodsA systematic search of 8 electronic databases was conducted to identify relevant RCTs. Meta-analysis was performed using Stata 18.0. Meta-regression, subgroup analyses, sensitivity analyses, and publication bias analyses were conducted to further examine results, and reliability of findings was assessed using TSA and GRADE.Results20 RCTs involving 1,704 patients were included. Meta-analysis results showed that, thymosin α1 combined with chemotherapy was associated with higher ORR (RR = 1.39), DCR (RR = 1.16), and KPS scores (WMD = 8.27). Regarding immune function, combination therapy resulted in higher CD3+% (WMD = 7.73), CD4+% (WMD = 6.87), CD4+/CD8+ (WMD = 0.42), and NK cell (WMD = 4.73). Regarding tumor markers, combination therapy resulted in lower levels of CEA (WMD = −5.48) and CA199 (WMD = −9.06). Regarding inflammatory factors, combination therapy may reduce levels of MMP-2, MMP-9, IL-4, and IL-10, while increasing levels of IFN-γ and TNF-α. Regarding safety, combination therapy was associated with reductions in gastrointestinal reactions (RR = 0.63), myelosuppression (RR = 0.60), abnormal liver function (RR = 0.54), and neurotoxicity (RR = 0.47). However, included RCTs did not systematically report long-term survival outcomes, and their methodological quality was limited; and GRADE indicated that quality of evidence for outcomes ranged from very low to moderate.ConclusionThe combination of thymosin α1 with chemotherapy is associated with improved short-term efficacy, enhanced immune function, improved quality of life, and a reduced incidence of adverse reactions in patients with gastric cancer, indicating good potential for clinical application. However, it remains unclear whether this approach can provide long-term benefits for patients with gastric cancer. Furthermore, given that studies included were all small-sample studies conducted in China and were of limited quality, certainty of evidence is low; these conclusions require further validation through additional high-quality studies.Systematic Review Registrationhttps://www.crd.york.ac.uk/PROSPERO/, Identifier CRD420261282679.
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