Efficacy and safety of thymosin α1 combined with chemotherapy for gastric cancer: a systematic review and meta-analysis of randomized controlled trials.

Wang Z, Sun T, Qu H, Zhao R, Shan X, Liu Y, Zheng Y

Frontiers in immunology18 Sept 2026

PMID42827862PMCIDPMC13630780DOI10.3389/fimmu.2026.1884797PepBankPUB-42827862

Summary

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.

CC BYText from Europe PMC. Highlighted sentences are the source of results.

Results from this study19

19 results from studies that gave the peptide. 19 results from people.

01HumanSystematic reviewEfficacy outcome
In patients with gastric cancer, thymosin α1 combined with chemotherapy was associated with a higher objective response rate (ORR) in a meta-analysis of RCTs.
In plain wordsIn people with gastric cancer, adding thymosin α1 to chemotherapy was linked to a higher tumour response rate in pooled trials.
Peptide
Thymosin alpha-1
Outcome
IncreaseObjective response rate (ORR)
Study
n: not reported in source
Outcome group
Tumor growth · Cancer
Studied dose
Dose not stated
Measurements
RR
1.39 ratio
ORR
Source sentences
Summary
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).
1 context sentence(design, population, supporting numbers)
Summary · context
20 RCTs involving 1,704 patients were included.
Show in the study text Report a problemFND-4282786201
02HumanSystematic reviewEfficacy outcome
In patients with gastric cancer, thymosin α1 combined with chemotherapy was associated with a higher disease control rate (DCR).
In plain wordsIn people with gastric cancer, adding thymosin α1 to chemotherapy was linked to a higher disease control rate in pooled trials.
Peptide
Thymosin alpha-1
Outcome
IncreaseDisease control rate (DCR)
Study
n: not reported in source
Outcome group
Tumor growth · Cancer
Studied dose
Dose not stated
Measurements
RR
1.16 ratio
DCR
Source sentences
Summary
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).
1 context sentence(design, population, supporting numbers)
Summary · context
20 RCTs involving 1,704 patients were included.
Show in the study text Report a problemFND-4282786202
03HumanSystematic reviewEfficacy outcome
In patients with gastric cancer, thymosin α1 combined with chemotherapy was associated with higher KPS scores.
In plain wordsIn people with gastric cancer, adding thymosin α1 to chemotherapy was linked to higher performance scores in pooled trials.
Peptide
Thymosin alpha-1
Outcome
IncreaseKarnofsky performance status (KPS) score
Study
n: not reported in source
Outcome group
Quality of life · Whole body
Studied dose
Dose not stated
Measurements
WMD
8.27 points
KPS score
Source sentences
Summary
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).
1 context sentence(design, population, supporting numbers)
Summary · context
20 RCTs involving 1,704 patients were included.
Show in the study text Report a problemFND-4282786203
04HumanSystematic reviewEfficacy outcome
In patients with gastric cancer, thymosin α1 combined with chemotherapy resulted in a higher CD3+ percentage.
In plain wordsIn people with gastric cancer, adding thymosin α1 to chemotherapy was linked to a higher share of CD3+ immune cells.
Peptide
Thymosin alpha-1
Outcome
IncreaseCD3+ percentage
Study
n: not reported in source
Outcome group
Immune response · Immune and inflammation
Studied dose
Dose not stated
Measurements
WMD
7.73%
CD3+%
Source sentences
Summary
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).
1 context sentence(design, population, supporting numbers)
Summary · context
20 RCTs involving 1,704 patients were included.
Show in the study text Report a problemFND-4282786204
05HumanSystematic reviewEfficacy outcome
In patients with gastric cancer, thymosin α1 combined with chemotherapy resulted in a higher CD4+ percentage.
In plain wordsIn people with gastric cancer, adding thymosin α1 to chemotherapy was linked to a higher share of CD4+ immune cells.
Peptide
Thymosin alpha-1
Outcome
IncreaseCD4+ percentage
Study
n: not reported in source
Outcome group
Immune response · Immune and inflammation
Studied dose
Dose not stated
Measurements
WMD
6.87%
CD4+%
Source sentences
Summary
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).
1 context sentence(design, population, supporting numbers)
Summary · context
20 RCTs involving 1,704 patients were included.
Show in the study text Report a problemFND-4282786205
06HumanSystematic reviewEfficacy outcome
In patients with gastric cancer, thymosin α1 combined with chemotherapy resulted in a higher CD4+/CD8+ ratio.
In plain wordsIn people with gastric cancer, adding thymosin α1 to chemotherapy was linked to a higher CD4+/CD8+ immune cell ratio.
Peptide
Thymosin alpha-1
Outcome
IncreaseCD4+/CD8+ ratio
Study
n: not reported in source
Outcome group
Immune response · Immune and inflammation
Studied dose
Dose not stated
Measurements
WMD
0.42 ratio
CD4+/CD8+
Source sentences
Summary
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).
1 context sentence(design, population, supporting numbers)
Summary · context
20 RCTs involving 1,704 patients were included.
Show in the study text Report a problemFND-4282786206
07HumanSystematic reviewEfficacy outcome
In patients with gastric cancer, thymosin α1 combined with chemotherapy resulted in higher NK cell levels.
In plain wordsIn people with gastric cancer, adding thymosin α1 to chemotherapy was linked to higher natural killer cell levels.
Peptide
Thymosin alpha-1
Outcome
IncreaseNK cells
Study
n: not reported in source
Outcome group
Immune response · Immune and inflammation
Studied dose
Dose not stated
Measurements
WMD
4.73
NK cell
Source sentences
Summary
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).
1 context sentence(design, population, supporting numbers)
Summary · context
20 RCTs involving 1,704 patients were included.
Show in the study text Report a problemFND-4282786207
08HumanSystematic reviewEfficacy outcome
In patients with gastric cancer, thymosin α1 combined with chemotherapy resulted in lower CEA levels.
In plain wordsIn people with gastric cancer, adding thymosin α1 to chemotherapy was linked to lower levels of the tumour marker CEA.
Peptide
Thymosin alpha-1
Outcome
DecreaseCEA level
Study
n: not reported in source
Outcome group
Endogenous peptide levels · Cancer
Studied dose
Dose not stated
Measurements
WMD
−5.48
CEA
Source sentences
Summary
Regarding tumor markers, combination therapy resulted in lower levels of CEA (WMD = -5.48) and CA199 (WMD = -9.06).
1 context sentence(design, population, supporting numbers)
Summary · context
20 RCTs involving 1,704 patients were included.
Show in the study text Report a problemFND-4282786208
09HumanSystematic reviewEfficacy outcome
In patients with gastric cancer, thymosin α1 combined with chemotherapy resulted in lower CA199 levels.
In plain wordsIn people with gastric cancer, adding thymosin α1 to chemotherapy was linked to lower levels of the tumour marker CA199.
Peptide
Thymosin alpha-1
Outcome
DecreaseCA199 level
Study
n: not reported in source
Outcome group
Endogenous peptide levels · Cancer
Studied dose
Dose not stated
Measurements
WMD
−9.06
CA199
Source sentences
Summary
Regarding tumor markers, combination therapy resulted in lower levels of CEA (WMD = -5.48) and CA199 (WMD = -9.06).
1 context sentence(design, population, supporting numbers)
Summary · context
20 RCTs involving 1,704 patients were included.
Show in the study text Report a problemFND-4282786209
10HumanSystematic reviewMechanism
In patients with gastric cancer, thymosin α1 combined with chemotherapy may reduce MMP-2 levels.
In plain wordsIn people with gastric cancer, adding thymosin α1 to chemotherapy may lower MMP-2, an inflammation-related factor.
Peptide
Thymosin alpha-1
Outcome
DecreaseMMP-2 level
Study
n: not reported in source
Outcome group
Inflammation markers · Immune and inflammation
Studied dose
Dose not stated
Source sentences
Summary
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.
1 context sentence(design, population, supporting numbers)
Summary · context
20 RCTs involving 1,704 patients were included.
Show in the study text Report a problemFND-4282786210
11HumanSystematic reviewMechanism
In patients with gastric cancer, thymosin α1 combined with chemotherapy may reduce MMP-9 levels.
In plain wordsIn people with gastric cancer, adding thymosin α1 to chemotherapy may lower MMP-9, an inflammation-related factor.
Peptide
Thymosin alpha-1
Outcome
DecreaseMMP-9 level
Study
n: not reported in source
Outcome group
Inflammation markers · Immune and inflammation
Studied dose
Dose not stated
Source sentences
Summary
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.
1 context sentence(design, population, supporting numbers)
Summary · context
20 RCTs involving 1,704 patients were included.
Show in the study text Report a problemFND-4282786211
12HumanSystematic reviewMechanism
In patients with gastric cancer, thymosin α1 combined with chemotherapy may reduce IL-4 levels.
In plain wordsIn people with gastric cancer, adding thymosin α1 to chemotherapy may lower IL-4, an inflammation-related factor.
Peptide
Thymosin alpha-1
Outcome
DecreaseIL-4 level
Study
n: not reported in source
Outcome group
Inflammation markers · Immune and inflammation
Studied dose
Dose not stated
Source sentences
Summary
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.
1 context sentence(design, population, supporting numbers)
Summary · context
20 RCTs involving 1,704 patients were included.
Show in the study text Report a problemFND-4282786212
13HumanSystematic reviewMechanism
In patients with gastric cancer, thymosin α1 combined with chemotherapy may reduce IL-10 levels.
In plain wordsIn people with gastric cancer, adding thymosin α1 to chemotherapy may lower IL-10, an inflammation-related factor.
Peptide
Thymosin alpha-1
Outcome
DecreaseIL-10 level
Study
n: not reported in source
Outcome group
Inflammation markers · Immune and inflammation
Studied dose
Dose not stated
Source sentences
Summary
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.
1 context sentence(design, population, supporting numbers)
Summary · context
20 RCTs involving 1,704 patients were included.
Show in the study text Report a problemFND-4282786213
14HumanSystematic reviewMechanism
In patients with gastric cancer, thymosin α1 combined with chemotherapy may increase IFN-γ levels.
In plain wordsIn people with gastric cancer, adding thymosin α1 to chemotherapy may raise IFN-γ, an immune signalling factor.
Peptide
Thymosin alpha-1
Outcome
IncreaseIFN-γ level
Study
n: not reported in source
Outcome group
Inflammation markers · Immune and inflammation
Studied dose
Dose not stated
Source sentences
Summary
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.
1 context sentence(design, population, supporting numbers)
Summary · context
20 RCTs involving 1,704 patients were included.
Show in the study text Report a problemFND-4282786214
15HumanSystematic reviewMechanism
In patients with gastric cancer, thymosin α1 combined with chemotherapy may increase TNF-α levels.
In plain wordsIn people with gastric cancer, adding thymosin α1 to chemotherapy may raise TNF-α, an immune signalling factor.
Peptide
Thymosin alpha-1
Outcome
IncreaseTNF-α level
Study
n: not reported in source
Outcome group
Inflammation markers · Immune and inflammation
Studied dose
Dose not stated
Source sentences
Summary
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.
1 context sentence(design, population, supporting numbers)
Summary · context
20 RCTs involving 1,704 patients were included.
Show in the study text Report a problemFND-4282786215
16HumanSystematic reviewSafety outcome
In patients with gastric cancer, thymosin α1 combined with chemotherapy was associated with fewer gastrointestinal reactions.
In plain wordsIn people with gastric cancer, adding thymosin α1 to chemotherapy was linked to fewer gut side effects in pooled trials.
Peptide
Thymosin alpha-1
Outcome
DecreaseGastrointestinal reactions
Study
n: not reported in source
Outcome group
Gastrointestinal adverse events · Gastrointestinal
Studied dose
Dose not stated
Measurements
RR
0.63 ratio
gastrointestinal reactions
Source sentences
Summary
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).
1 context sentence(design, population, supporting numbers)
Summary · context
20 RCTs involving 1,704 patients were included.
Show in the study text Report a problemFND-4282786216
17HumanSystematic reviewSafety outcome
In patients with gastric cancer, thymosin α1 combined with chemotherapy was associated with less myelosuppression.
In plain wordsIn people with gastric cancer, adding thymosin α1 to chemotherapy was linked to less bone marrow suppression in pooled trials.
Peptide
Thymosin alpha-1
Outcome
DecreaseMyelosuppression
Study
n: not reported in source
Outcome group
Adverse events · Whole body
Studied dose
Dose not stated
Measurements
RR
0.6 ratio
myelosuppression
Source sentences
Summary
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).
1 context sentence(design, population, supporting numbers)
Summary · context
20 RCTs involving 1,704 patients were included.
Show in the study text Report a problemFND-4282786217
18HumanSystematic reviewSafety outcome
In patients with gastric cancer, thymosin α1 combined with chemotherapy was associated with less abnormal liver function.
In plain wordsIn people with gastric cancer, adding thymosin α1 to chemotherapy was linked to fewer liver function problems in pooled trials.
Peptide
Thymosin alpha-1
Outcome
DecreaseAbnormal liver function
Study
n: not reported in source
Outcome group
Adverse events · Liver
Studied dose
Dose not stated
Measurements
RR
0.54 ratio
abnormal liver function
Source sentences
Summary
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).
1 context sentence(design, population, supporting numbers)
Summary · context
20 RCTs involving 1,704 patients were included.
Show in the study text Report a problemFND-4282786218
19HumanSystematic reviewSafety outcome
In patients with gastric cancer, thymosin α1 combined with chemotherapy was associated with less neurotoxicity.
In plain wordsIn people with gastric cancer, adding thymosin α1 to chemotherapy was linked to less nerve toxicity in pooled trials.
Peptide
Thymosin alpha-1
Outcome
DecreaseNeurotoxicity
Study
n: not reported in source
Outcome group
Adverse events · Nervous system and cognition
Studied dose
Dose not stated
Measurements
RR
0.47 ratio
neurotoxicity
Source sentences
Summary
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).
1 context sentence(design, population, supporting numbers)
Summary · context
20 RCTs involving 1,704 patients were included.
Show in the study text Report a problemFND-4282786219

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Version history

PepBank keeps every version of the data on this study. Status changes from Retraction Watch, Europe PMC and Crossref are listed with their source.

Version 3Current
9 Oct 2026, 18:17 UTC
Study results updated
Version 2
9 Oct 2026, 03:03 UTC
Study data updated · source update from Europe PMC
Version 1
9 Oct 2026, 03:02 UTC
First added · source update from Europe PMC

Efficacy and safety of thymosin α1 combined with chemotherapy for gastric cancer: a systematic review and meta-analysis of randomized controlled trials.

Summary

Results from this study19

Version history

Subjects

Publication types

MeSH terms

Keywords