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Jenča A, Mills DK, Ghasemi H, Saberian E, Jenča A, Karimi Forood AM, Petrášová A, Jenčová J, Jabbari Velisdeh Z, Zare-Zardini H, Ebrahimifar M. Herbal Therapies for Cancer Treatment: A Review of Phytotherapeutic Efficacy. Biologics 2024; 18:229-255. [PMID: 39281032 PMCID: PMC11401522 DOI: 10.2147/btt.s484068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 08/31/2024] [Indexed: 09/18/2024]
Abstract
Natural products have proven to be promising anti-cancer agents due to their diverse chemical structures and bioactivity. This review examines their central role in cancer treatment, focusing on their mechanisms of action and therapeutic benefits. Medicinal plants contain bioactive compounds, such as flavonoids, alkaloids, terpenoids and polyphenols, which exhibit various anticancer properties. These compounds induce apoptosis, inhibit cell proliferation and cell cycle progression, interfere with microtubule formation, act on topoisomerase targets, inhibit angiogenesis, modulate key signaling pathways, improve the tumor microenvironment, reverse drug resistance and activate immune cells. Herbal anti-cancer drugs offer therapeutic advantages, particularly selective toxicity against cancer cells, reducing the adverse side effects associated with conventional chemotherapy. Recent studies and clinical trials highlight the benefits of herbal medicines in alleviating side effects, improving tolerance to chemotherapy and the occurrence of synergistic effects with conventional treatments. For example, the herbal medicine SH003 was found to be safe and potentially effective in the treatment of solid cancers, while Fucoidan showed anti-inflammatory properties that are beneficial for patients with advanced cancer. The current research landscape on herbal anticancer agents is extensive. Numerous studies and clinical trials are investigating their efficacy, safety and mechanisms of action in various cancers such as lung, prostate, breast and hepatocellular carcinoma. Promising developments include the polypharmacological approach, combination therapies, immunomodulation and the improvement of quality of life. However, there are still challenges in the development and use of natural products as anti-cancer drugs, such as the need for further research into their mechanisms of action, possible drug interactions and optimal dosage. Standardizing herbal extracts, improving bioavailability and delivery, and overcoming regulatory and acceptance hurdles are critical issues that need to be addressed. Nonetheless, the promising anticancer effects and therapeutic benefits of natural products warrant further investigation and development. Multidisciplinary collaboration is essential to advance herbal cancer therapy and integrate these agents into mainstream cancer treatment.
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Affiliation(s)
- Andrej Jenča
- Klinika of Stomatology and Maxillofacial Surgery Akadémia Košice Bacikova, UPJS LF, Kosice, Slovakia
| | - David K Mills
- Molecular Science and Nanotechnology, College of Engineering and Science, Louisiana Tech University, Ruston, LA, 71272, USA
| | - Hadis Ghasemi
- Department of Chemistry, College of Art and Science, Southern Illinois University Edwardsville, Edwardsville, IL, USA
| | - Elham Saberian
- Pavol Jozef Šafárik University, Klinika and Akadémia Košice Bacikova, Kosice, Slovakia
| | - Andrej Jenča
- Klinika of Stomatology and Maxillofacial Surgery Akadémia Košice Bacikova, UPJS LF, Kosice, Slovakia
| | | | - Adriána Petrášová
- Klinika of Stomatology and Maxillofacial Surgery Akadémia Košice Bacikova, UPJS LF, Kosice, Slovakia
| | - Janka Jenčová
- Klinika of Stomatology and Maxillofacial Surgery Akadémia Košice Bacikova, UPJS LF, Kosice, Slovakia
| | - Zeinab Jabbari Velisdeh
- Molecular Science and Nanotechnology, College of Engineering and Science, Louisiana Tech University, Ruston, LA, 71272, USA
| | - Hadi Zare-Zardini
- Department of Biomedical Engineering, Meybod University, Meybod, Iran
| | - Meysam Ebrahimifar
- Department of Toxicology, Faculty of Pharmacy, Islamic Azad University, Shahreza Branch, Shahreza
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Bazrafshani MS, Pardakhty A, Kalantari Khandani B, Tajadini H, Ghazanfari Pour S, Hashemi S, Amiri S, Mehmandoost S, Beigzadeh A, Abbaszadeh S, Sharifi H. The prevalence and predictors of herb-drug interactions among Iranian cancer patients during chemotherapy courses. BMC Complement Med Ther 2023; 23:41. [PMID: 36750849 PMCID: PMC9903537 DOI: 10.1186/s12906-023-03869-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 01/31/2023] [Indexed: 02/09/2023] Open
Abstract
BACKGROUND The concurrent usage of herbal medicines with conventional therapies is an important concern in cancer treatment which can lead to unexpected consequences like herb-drug interactions. This study aimed to determine the prevalence of potential herb-drug interactions and to predict factors associated with herb-drug interactions for cancer patients. METHODS This cross-sectional study was conducted among a convenience sample of 315 cancer patients referring to the oncology clinics of Kerman city in 2018. Data were collected via comprehensive face-to-face interviews and medical chart reviews. A drug interaction checker was used to determine herb-drug interactions. The information of patients was compared based on herb-drug interactions using bivariable logistic regression models, and predictors were determined by the multivariable logistic regression model. All analyses were performed by Stata software version 16. RESULTS Of 262 patients (83.2% of the patients) who used herbal medicines, 209 patients [79.8% (95% Confidence Intervals (CI): 75.2 - 85.1)] had potential herb-drug interactions. Chamomile was the most popular herbal medicine (n = 163, 78.0%), and minor and moderate herb-drug interactions were caused by green tea (n = 34, 16.3%) and peppermint (n = 78, 37.5%). The number of chemotherapeutic agents (OR: 1.92, 95% CI: 1.43-2.58; P-value < 0.0001) and the experienced of pain during chemotherapy courses (OR = 2.22, 95%CI:1.00-4.94; P-value = 0.04) were some of the predictors of herb-drug interactions among cancer patients. CONCLUSION Herbal medicine use during chemotherapy was found prevalent among cancer patients; of them, the experience of potential herb-drug interactions was highly frequent. Oncologists and clinical pharmacologists are recommended to take into account challenges associated with herb-drug interactions in their routine practices, particularly during chemotherapy among these patients.
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Affiliation(s)
- Maliheh Sadat Bazrafshani
- grid.412105.30000 0001 2092 9755HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 7616914111 Iran
| | - Abbas Pardakhty
- Pharmaceutics Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran.
| | - Behjat Kalantari Khandani
- grid.412105.30000 0001 2092 9755Department of Internal Medicine, Hematology and Oncology Division, Kerman University of Medical Sciences, Kerman, Iran
| | - Haleh Tajadini
- grid.412105.30000 0001 2092 9755Physiology Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran
| | - Sadra Ghazanfari Pour
- grid.412105.30000 0001 2092 9755Student Research Committee, Kerman University of Medical Sciences, Kerman, Iran
| | - Sara Hashemi
- grid.412105.30000 0001 2092 9755Departement of Medical Chemistry, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Shiva Amiri
- grid.412105.30000 0001 2092 9755Pharmaceutics Research Center, Neuropharmacology Institute, Kerman University of Medical Sciences, Kerman, Iran ,grid.412105.30000 0001 2092 9755Department of Toxicology and Pharmacology, Faculty of Pharmacy, Kerman University of Medical Sciences, Kerman, Iran
| | - Soheil Mehmandoost
- grid.412105.30000 0001 2092 9755HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 7616914111 Iran
| | | | - Samaneh Abbaszadeh
- grid.412105.30000 0001 2092 9755HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 7616914111 Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, 7616914111, Iran.
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Cytochrome P-450-mediated herb and food-drug interactions can be identified in cancer patients through patient self-reporting with a tablet application: results of a prospective observational study. ESMO Open 2022; 7:100650. [PMID: 36493603 PMCID: PMC9808458 DOI: 10.1016/j.esmoop.2022.100650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 09/21/2022] [Accepted: 10/24/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Consumption of herbs, food used as medicine and dietary supplements (HFDSs) is common in cancer patients. Herbs and food-drug interactions (HFDIs) can lead to serious adverse effects and can be prevented. We previously reviewed cytochrome P-450 (CYP)-mediated HFDI for 261 HFDSs and we classified the risk of CYP inhibition and induction on a level of evidence scale from 1 (high evidence, supported by several clinical studies) to 5 (low evidence, only limited preclinical data). PATIENTS AND METHODS We conducted a prospective, non-interventional study (NCT04128865) to assess whether self-assessment of patients could detect HFDI classified as 'probable' (i.e. level 1, 2 or 3 of the scale) in a population of cancer patients. Patients were invited through a tablet application to report their consumption of herbs, regular CYP-interacting food consumption and dietary supplements, as well as some clinical data and cancer treatments. The patient's completion of the survey could be supervised by a health care professional or not. A prespecified threshold of 5% of HFDIs classified as 'probable' detected with the application was deemed relevant. RESULTS Between 29 March 2018 and 22 June 2018, 143 patients completed the survey. Ninety-five patients (66%) reported at least one current systemic cancer treatment and were included in the analyses. Seventy-four patients reported an intake of at least one HFDS (77.9%), while 21 patients reported no HFDS (22.1%). Twenty-two HFDIs classified as 'probable' were found in 16 patients (16.8%) with the application, which was significantly superior to the prespecified threshold (P = 0.02). The interactions were reported with food (n = 19, 86%) more frequently than with herbs (n = 3, 14%) or with dietary supplements (no interaction reported). CONCLUSIONS Self-assessment of HFDS interaction with cancer treatment with an application is feasible and should be considered in daily routine. Prospective interventional studies should be conducted to better assess the clinical benefits of this approach.
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Lam CS, Koon HK, Ma CT, Au KY, Zuo Z, Chung VCH, Cheung YT. Real-world data on herb-drug interactions in oncology: A scoping review of pharmacoepidemiological studies. PHYTOMEDICINE : INTERNATIONAL JOURNAL OF PHYTOTHERAPY AND PHYTOPHARMACOLOGY 2022; 103:154247. [PMID: 35716539 DOI: 10.1016/j.phymed.2022.154247] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 05/14/2022] [Accepted: 06/05/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The concurrent use of conventional drugs and herbal medicines is becoming popular among patients with cancer. However, the potential risk of herb-drug interactions (HDI) remains under-addressed in the literature. Previous reviews have mainly focused on the prevalence of interactions, with less attention paid to the methods used by pharmacoepidemiological studies on evaluating HDI. This scoping review aims to summarize the existing pharmacoepidemiological studies that evaluate HDI using real-world data and to identify gaps to be addressed in future research. METHODS A comprehensive search was performed in nine English- and Chinese-language databases from their inception to May 2021. Gray literature and manual searches were conducted to identify additional studies. The recommended components of the pharmacoepidemiological studies and key findings related to HDI were summarized. The proportion (%) of patients with cancer at risk of HDI was estimated by combining data from eligible studies. RESULTS Twenty-eight studies were included in the review. More than half of these studies were cross-sectional studies (n = 18, 64.3%), followed by retrospective cohort studies (n = 5, 17.9%) and prospective cohort studies (n = 2, 7.1%). The three cancer drugs most commonly studied for their interaction potential with herbs were tamoxifen (n = 11, 39.3%), cyclophosphamide (n = 6, 21.4%), and paclitaxel (n = 6, 21.4%). Most cross-sectional studies identified potential HDI using tertiary databases and primary literature searches. Conversely, prospective and retrospective studies mainly investigated actual clinical outcomes, such as adverse events and secondary cancer occurrences. Most interaction outcomes identified using real-world data did not lead to negative clinical consequences. Collectively, 45.4% of herbal medicine users of the included studies were found to be at risk of HDI. We infer from this review that the common limitations of these studies were limited sample size, lack of data on herbal medicine use and details of HDI, and lack of evidence of HDI. Based on the study limitations, several recommendations to enrich the data sources and optimize the study designs were proposed. CONCLUSIONS There is a high demand for pharmacoepidemiological research on HDI, considering the increasing popularity of herbal medicine among patients with cancer. It is anticipated that emerging real-world data in this field can guide the development of safe and effective approaches to integrative oncology.
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Affiliation(s)
- Chun Sing Lam
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Area 39, Shatin, NT, Hong Kong
| | - Ho Kee Koon
- School of Chinese Medicine, Faculty of Medicine, Chung Chi College, The Chinese University of Hong Kong, Room 101, Li Wai Chun Building, Shatin, NT, Hong Kong
| | - Chung Tin Ma
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Area 39, Shatin, NT, Hong Kong
| | - Kwok Yin Au
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Prince of Wales Hospital, 4L, 4/F, Day Treatment Block, Shatin, NT, Hong Kong
| | - Zhong Zuo
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Area 39, Shatin, NT, Hong Kong
| | - Vincent Chi-Ho Chung
- School of Chinese Medicine, Faculty of Medicine, Chung Chi College, The Chinese University of Hong Kong, Room 101, Li Wai Chun Building, Shatin, NT, Hong Kong; Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Prince of Wales Hospital, Room 202, School of Public Health Building, Shatin, NT, Hong Kong
| | - Yin Ting Cheung
- School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Area 39, Shatin, NT, Hong Kong.
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Escudero-Vilaplana V, Collado-Borrell R, Gómez Martínez-Sagrera P, Villanueva-Bueno C, Revuelta-Herrero JL, Gonzalez-Haba E, Hoyo-Muñoz Á, Jerez Gilarranz Y, Marzal-Alfaro B, Herranz A, Martin M, Sanjurjo M. Complementary and alternative medicine in cancer patients: characteristics of use and interactions with antineoplastic agents. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04172-1. [PMID: 35790560 DOI: 10.1007/s00432-022-04172-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 06/22/2022] [Indexed: 06/15/2023]
Abstract
PURPOSE Our objectives were to analyze the use of complementary and alternative medicine (CAM) in cancer patients and to describe the incidence and characteristics of interactions between CAM and antineoplastic agents. METHODS We performed an observational study in cancer outpatients at a university hospital. Variables were collected through a 22-item questionnaire. Potential interactions between CAM and antineoplastic agents were analyzed using the Lexicomp®, the About Herbs®, and the summary of product characteristics. Mechanism of action, reliability, and the potential clinical effect of interactions were analyzed. RESULTS The study population comprised 937 patients, of whom 65% used CAM (70.6% herbal products, 25.8% dietary supplements, and 3.6% homeopathy). Female sex, younger age, and breast cancer were associated with more frequent use of CAM. The primary source of information about CAM was friends and family (43.5%). A total of 335 (57.1%) patients did not tell their doctor that they took CAM. The five most common CAM were chamomile, green tea, pennyroyal mint, linden, and rooibos. At least one interaction between CAM and antineoplastic agents was reported by 65.0% of CAM users (33.9% of all patients). Depending on the mechanism of action, 80% of CAM diminished the metabolism of the antineoplastic agents. CONCLUSION Our results reveal a high incidence of interactions between CAM and antineoplastic agents. The most frequent CAM were herbal products. Family and friends were the primary sources of information that led patients to start taking CAM, and more than half of the patients did not tell their doctor that they were taking CAM.
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Affiliation(s)
- Vicente Escudero-Vilaplana
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
| | - Roberto Collado-Borrell
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Patricia Gómez Martínez-Sagrera
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Cristina Villanueva-Bueno
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - José Luis Revuelta-Herrero
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Eva Gonzalez-Haba
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ángela Hoyo-Muñoz
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Yolanda Jerez Gilarranz
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CiberOnc, Madrid, Spain
| | - Belén Marzal-Alfaro
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Ana Herranz
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
| | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- CiberOnc, Madrid, Spain
| | - María Sanjurjo
- Pharmacy Department, Hospital General Universitario Gregorio Marañón, Doctor Esquerdo, 46, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain
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Sulaiman MK, Lakshmanan J. Systemic and Anticancer Potential of Adaptogenic Constituents Isolated from Traditional Herbs - A Mini-Review. Anticancer Agents Med Chem 2022; 22:2811-2821. [PMID: 35400325 DOI: 10.2174/1871520622666220408091610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 01/21/2022] [Accepted: 02/23/2022] [Indexed: 11/22/2022]
Abstract
Adaptogens were initially recognized as stress-resistance inducing compounds. Recent studies reveal that adaptogens are pleiotropically-acting chemical constituents that can be isolated from traditional herbs. They are gaining increasing attention in cancer chemotherapy. This review summarizes the physiological action of adaptogens isolated from the 9 most widely used traditional herbs implicated in cancer therapy viz., Withania somnifera, Tinospora cordifolia, Rhodiola rosea, Emblica officinalis, Glycyrrhiza glabra, Bacopa monnieri, Asparagus racemosus, Ocimum sanctum, and Panax notoginseng. The studies were identified through a systematic search of major computerized databases such as Pubmed, Embase, Medline, Inflibnet, Google Scholar, and Cochrane Library. Individual names of each herb and biological action were the search terms employed. In this review, we have enlisted the chemical constituents and their mechanism of action in a few organ systems as well as in cancer cells. Studies indicate that the adaptogens isolated from these herbs can be broadly arranged into 2 classes based on their chemical structure. These molecules exert a positive influence on several organ systems such as respiratory, nervous, cardiovascular, immune, and gastrointestinal tract. It is also clear that adaptogens act as effective chemopreventive agents alone or in combination with chemo drugs in multiple cancers by targeting multiple intracellular target proteins. Therefore, we conclude that adaptogens are versatile ligands capable of eliciting many systemic effects. Their biological functions are complex, varied, and context-dependent in various cancers. This offers great scope for personalized treatment and cancer chemoprevention in the future.
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Affiliation(s)
| | - Jaganathan Lakshmanan
- Dr. Hiram C. Polk, Jr., Department of Surgery, University of Louisville, 511, S FLoyd St, MDR Building, RM#317, Louisville, KY 40202. USA
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Hu J, Jiang J, Liu R, Cheng M, Zhu G, He S, Shi B, Zhao Y, He Z, Yu H, Zhang X, Zheng H, Hua B. Clinical Efficacy and Safety of Traditional Medicine Preparations Combined With Chemotherapy for Advanced Pancreatic Cancer: A Systematic Review and Meta-Analysis. Front Oncol 2022; 12:828450. [PMID: 35280766 PMCID: PMC8904728 DOI: 10.3389/fonc.2022.828450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 01/20/2022] [Indexed: 12/11/2022] Open
Abstract
Background Traditional medicine preparations (TMPs) combined with chemotherapy is widely used for patients with advanced pancreatic cancer (APC); however, its efficacy and safety are still unclear. The purpose of this meta-analysis was to evaluate the clinical efficacy and safety of TMPs combined with chemotherapy for the treatment of APC. Methods A systematic search of eight electronic databases for randomized controlled trials (RCTs) was conducted from inception to October 15, 2021. Tumor response was identified as primary outcome, whereas quality of life (QoL), cancer biomarkers, and adverse drug reactions (ADRs) were identified as secondary outcomes. Quality of the evidence for each outcome was evaluated by GRADE profiler. Results In total, 31 RCTs involving 1,989 individuals were included. This meta-analysis showed that TMPs combined with chemotherapy significantly improved the objective response rate (ORR) (RR=1.64, 95% CI [1.43 to 1.88], p <0.00001), disease control rate (DCR) (RR=1.29, 95% CI [1.21 to 1.38], p <0.00001), and QoL (continuous data: SMD=0.81, 95% CI [0.44 to 1.18], p <0.0001, dichotomous data: RR=1.44, 95% CI [1.22 to 1.70], p<0.0001), compared to those with chemotherapy alone. In addition, the combined treatment group also had lower levels of CA19-9 (SMD=-0.46, 95% CI [-0.90 to -0.02], p=0.04) and CEA (SMD=-0.55, 95% CI [-0.93 to -0.17], p=0.004). Moreover, TMPs reduced the ADRs during chemotherapy. Conclusion This systematic review suggests that TMPs combined with chemotherapy might be a potential option to enhance therapeutic effects and reduce ADRs during the treatment of APC. However, more high-quality randomized controlled trials with more participants are needed. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=209825, identifier PROSPERO Number: CRD42021264938.
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Affiliation(s)
- Jiaqi Hu
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Juling Jiang
- Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Rui Liu
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Mengqi Cheng
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Guanghui Zhu
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Shulin He
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.,Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Bolun Shi
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Yuwei Zhao
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Zhongning He
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Huibo Yu
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Xing Zhang
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Honggang Zheng
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Baojin Hua
- Department of Oncology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Chen L, Ji N, Zhang M, Chen W. The Influence of Wuzhi Capsule on the Pharmacokinetics of Cyclophosphamide. Recent Pat Anticancer Drug Discov 2021; 17:195-203. [PMID: 34758719 DOI: 10.2174/1574892816666211110152119] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 08/15/2021] [Accepted: 08/25/2021] [Indexed: 12/15/2022]
Abstract
BACKGROUND Cyclophosphamide is approved for the treatment of a variety of tumors, yet the use of cyclophosphamide is limited by kidney and liver toxicity. In the clinic, the Wuzhi capsule is approved to attenuate cyclophosphamide toxicity in the kidney and liver. OBJECTIVE We aimed to investigate the effects of the principal ingredients of Wuzhi capsule, schisandrin A (SIA) and schisantherin A (STA), on the pharmacokinetics of cyclophosphamide. METHODS The essential pharmacokinetic data and physicochemical parameters of SIA, STA, and cyclophosphamide were collected. Physiologically based pharmacokinetic (PBPK) models of SIA, STA, and cyclophosphamide were built in Simcyp Simulator and verified using published clinical pharmacokinetic data. The verified PBPK models were used to predict potential herb-drug interactions (HDIs) between cyclophosphamide and SIA and STA in cancer patients. RESULTS The area under the plasma concentration-time curve (AUC) of cyclophosphamide was increased by 18% and 1% when co-administered with STA and SIA at a single dose, respectively, and increased by 301% and 29% when co-administered with STA and SIA at multiple doses, respectively. The maximum concentration (Cmax) of cyclophosphamide was increased by 75% and 7% when co-administered with STA and SIA at multiple doses, respectively. CONCLUSION The AUC and Cmax of cyclophosphamide were increased when cyclophosphamide was combined with the Wuzhi capsule, compared to cyclophosphamide alone. Our study shows that the adverse drug reactions and toxicity of cyclophosphamide should be closely monitored and an effective dosage adjustment of cyclophosphamide may need to be considered when co-administered with the Wuzhi capsule.
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Affiliation(s)
- Lu Chen
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing. China
| | - Ning Ji
- Department of Pharmaceutical Sciences, College of Pharmacy and Health Sciences, St. John's University, Queens, NY. United States
| | - Min Zhang
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing. China
| | - Wanyi Chen
- Department of Pharmacy, Chongqing University Cancer Hospital, Chongqing. China
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Sun D, Sun C, Qiu G, Yao L, Yu J, Al Sberi H, Fouda MS, Othman MS, Lokman MS, Kassab RB, Abdel Moneim AE. Allicin mitigates hepatic injury following cyclophosphamide administration via activation of Nrf2/ARE pathways and through inhibition of inflammatory and apoptotic machinery. ENVIRONMENTAL SCIENCE AND POLLUTION RESEARCH INTERNATIONAL 2021; 28:39625-39636. [PMID: 33763830 DOI: 10.1007/s11356-021-13392-w] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 03/08/2021] [Indexed: 06/12/2023]
Abstract
Treatment with anti-neoplastic agents, including cyclophosphamide (CP), is associated with several adverse reactions. Here, we distinguished the potential protective effect of allicin against CP-mediated hepatotoxicity in rats. To assess the effect of allicin, four experimental groups were used, with 7 rats per group, including control, allicin (10 mg/kg), CP (200 mg/kg), and allicin + CP-treated groups. All groups were treated for 10 days. Blood and liver samples were collected for biochemical, molecular, and histological analyses. Treatment with CP led to deformations in the liver tissue that were associated with higher liver function markers (alanine transaminase, aspartate transaminase, and alkaline phosphatase). Additionally, a disturbance in the redox balance was observed after CP exposure, as indicated by increased levels of oxidants, including malondialdehyde and nitric oxide, and the decreased levels of endogenous antioxidants, including glutathione, glutathione peroxidase, glutathione reductase, superoxide dismutase, and catalase. At the molecular level, CP treatment resulted in reduced expression of the Nrf2/ARE pathway and other genes related to this pathway, including NAD(P)H quinone dehydrogenase 1 and glutamate-cysteine ligase catalytic subunit. CP also led to a hyper-inflammatory response in hepatic tissue, with increased production of pro-inflammatory cytokines, including tumor necrosis factor-alpha and interlukin-1beta, and upregulation of nitric oxide synthase 2. CP also enhanced the immunoreactivity of the profibrogenic cytokine, transforming growth factor-beta, in liver tissue. Upregulation of caspase 3 and Bcl-2-associated X protein and downregulation of B-cell lymphoma 2 were also observed in response to CP treatment. Treatment with allicin reversed the molecular, biochemical, and histological changes that occurred with CP exposure. These results suggest that allicin can be used in combination with CP to avoid hepatotoxicity.
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Affiliation(s)
- Dongsheng Sun
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Chen Sun
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Gongcai Qiu
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Lei Yao
- Department of General Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang, China
| | - Jian Yu
- Department of General Surgery, Shandong Provincial Qianfoshan Hospital, The First Affiliated Hospital of Shandong First Medical University, Jinan, 250014, Shandong, China.
| | - Hassan Al Sberi
- Basic Medical Science, Histopathology Department, National Organization for Drug Control and Research, Giza, Egypt
- Department of Biology, Faculty of Science, Taif University, Taif, Saudi Arabia
| | - Manar S Fouda
- Chemistry Department, Faculty of Science, Helwan University, Helwan, 11795, Egypt
| | - Mohamed S Othman
- Basic Sciences Department, Preparatory Year, University of Ha'il, Hail, Saudi Arabia
- Chemistry Department, Faculty of Biotechnology, October University for Modern Science and Arts (MSA), Giza, Egypt
| | - Maha S Lokman
- Biology Department, College of Science and Humanities, Prince Sattam Bin Abdul Aziz University, Alkharj, Saudi Arabia
- Department of Zoology and Entomology, Faculty of Science, Helwan University, Cairo, Egypt
| | - Rami B Kassab
- Department of Zoology and Entomology, Faculty of Science, Helwan University, Cairo, Egypt
- Biology Department, Faculty of Science and Arts, Al Baha University, Almakhwah Branch, Al Baha, Saudi Arabia
| | - Ahmed E Abdel Moneim
- Department of Zoology and Entomology, Faculty of Science, Helwan University, Cairo, Egypt
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10
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Wolf CPJG, Rachow T, Ernst T, Hochhaus A, Zomorodbakhsch B, Foller S, Rengsberger M, Hartmann M, Huebner J. Complementary and alternative medicine (CAM) supplements in cancer outpatients: analyses of usage and of interaction risks with cancer treatment. J Cancer Res Clin Oncol 2021; 148:1123-1135. [PMID: 34228225 PMCID: PMC9016053 DOI: 10.1007/s00432-021-03675-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 05/27/2021] [Indexed: 11/25/2022]
Abstract
Purpose The aim of our study was to analyze the use of complementary and alternative medicine (CAM) supplements, identify possible predictors, and analyze and compile potential interactions of CAM supplements with conventional cancer therapy. Methods We included outpatient cancer patients treated at a German university hospital in March or April 2020. Information was obtained from questionnaires and patient records. CAM–drug interactions were identified based on literature research for each active ingredient of the supplements consumed by the patients. Results 37.4% of a total of 115 patients consumed CAM supplements. Potential interactions with conventional cancer treatment were identified in 51.2% of these patients. All types of CAM supplements were revealed to be a potential source for interactions: vitamins, minerals, food and plant extracts, and other processed CAM substances. Younger age (< 62 years) (p = 0.020, φc = 0.229) and duration of individual cancer history of more than 1 year (p = 0.006, φc = 0.264) were associated with increased likelihood of CAM supplement use. A wide range of different CAM supplement interactions were reviewed: effects of antioxidants, cytochrome (CYP) interactions, and specific agonistic or antagonistic effects with cancer treatment. Conclusion The interaction risks of conventional cancer therapy with over-the-counter CAM supplements seem to be underestimated. Supplements without medical indication, as well as overdoses, should be avoided, especially in cancer patients. To increase patient safety, physicians should address the risks of interactions in physician–patient communication, document the use of CAM supplements in patient records, and check for interactions.
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Affiliation(s)
- Clemens P J G Wolf
- Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
| | - Tobias Rachow
- Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Pneumologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Thomas Ernst
- Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Konservative Tagesklinik des UniversitätsTumorCentrums (UTC), Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Andreas Hochhaus
- Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | | | - Susan Foller
- Klinik für Urologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Matthias Rengsberger
- Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Michael Hartmann
- Apotheke des Universitätsklinikums, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Jutta Huebner
- Klinik für Innere Medizin II, Hämatologie und Internistische Onkologie, Integrative Onkologie, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany
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11
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Gougis P, Hilmi M, Geraud A, Mir O, Funck-Brentano C. Potential Cytochrome P450-mediated pharmacokinetic interactions between herbs, food, and dietary supplements and cancer treatments. Crit Rev Oncol Hematol 2021; 166:103342. [PMID: 33930533 DOI: 10.1016/j.critrevonc.2021.103342] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/06/2021] [Accepted: 04/25/2021] [Indexed: 10/21/2022] Open
Abstract
Herbs, food and dietary supplements (HFDS), can interact significantly with anticancer drug treatments via cytochrome p450 isoforms (CYP) CYP3A4, CYP2D6, CYP1A2, and CYP2C8. The objective of this review was to assess the influence of HFDS compounds on these cytochromes. Interactions with CYP activities were searched for 189 herbs and food products, 72 dietary supplements in Web of Knowledge® databases. Analyses were made from 140 of 3,125 clinical trials and 236 of 3,374 in vitro, animal model studies or case reports. 18 trials were found to report direct interactions between 9 HFDS with 8 anticancer drugs. 21 HFDS were found to interact with CYP3A4, a major metabolic pathway for many anticancer drugs. All 261 HFDS were classified for their interaction with the main cytochromes P450 involved in the metabolism of anticancer drugs. We provided an easy-to-use colour-coded table to easily match potential interactions between 261 HFDS and 117 anticancer drugs.
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Affiliation(s)
- Paul Gougis
- Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013, Paris, France; CLIP² Galilée, Department of Medical Oncology Pitié-Salpêtrière Hospital, F-75013, Paris, France.
| | - Marc Hilmi
- Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013, Paris, France
| | - Arthur Geraud
- Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013, Paris, France; Early Drug Development Department (DITEP), Gustave Roussy, Villejuif, France
| | - Olivier Mir
- Department of Ambulatory Care, Gustave Roussy Cancer Campus, Villejuif, France
| | - Christian Funck-Brentano
- Sorbonne Université, INSERM CIC Paris-Est, AP-HP, ICAN, Pitié-Salpêtrière Hospital, Department of Pharmacology, F-75013, Paris, France
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12
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The potential of drug-herbal interaction among patients with chronic diseases in Saudi Arabia. Complement Ther Clin Pract 2021; 43:101324. [PMID: 33765548 DOI: 10.1016/j.ctcp.2021.101324] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 01/12/2021] [Accepted: 01/25/2021] [Indexed: 11/22/2022]
Abstract
AIMS This study aimed to estimate the prevalence of the potential drug-herbal interaction among patients with chronic diseases in Al-Kharj, Saudi Arabia and to explore factors associated with the potential of drug-herbal interaction. METHOD A cross-sectional study was conducted through interview-based questionnaire at outpatient clinics in Al-Kharj. The study included patients with chronic diseases who used herbal products. RESULTS This study included 336 patients in total. The mean age of participants was 52.4 ± 12.0 years, and their most-used medications were metformin, atorvastatin, and aspirin, while their most-used herbs were ginger (74.7%), mint (72%), and cumin (66.7%). In 310 out of 336 (92.26%) cases, at least one potential drug-herbal interaction was found, and most of these interactions (84%) were moderate. CONCLUSION A substantial percentage of potential drug-herbal interactions were found among patients with chronic diseases. Healthcare providers are encouraged to discuss the safety and efficacy of herbal products with their patients.
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13
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Lee RT, Kwon N, Wu J, To C, To S, Szmulewitz R, Tchekmedyian R, Holmes HM, Olopade OI, Stadler WM, Von Roenn J. Prevalence of potential interactions of medications, including herbs and supplements, before, during, and after chemotherapy in patients with breast and prostate cancer. Cancer 2021; 127:1827-1835. [PMID: 33524183 DOI: 10.1002/cncr.33324] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 10/07/2020] [Accepted: 10/20/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND The use of herbs and supplements (HS) is common among patients with cancer, yet limited information exists about potential medication interactions (PMIs) with HS use around chemotherapy. METHODS Patients with breast or prostate cancer who had recently finished chemotherapy at 2 academic medical centers were surveyed by telephone. Interviewers inquired about all medications, including HS, before, during, and after chemotherapy. Micromedex, Lexicomp, and Natural Medicines Comprehensive Database interaction software programs were used to determine PMIs. RESULTS A total of 67 subjects (age range, 39-77 years) were evaluated in this study. Participants were primarily White patients (73%) with breast cancer (87%). The median number of medications was 11 (range, 2-28) during the entire study and was highest during chemotherapy (7; range, 2-22). Approximately four-fifths (84%) used HS. A total of 1747 PMIs were identified, and they represented 635 unique PMIs across all 3 timeframes, with most occurring during chemotherapy. Prescription-related PMIs (70%) were the most common type, and they were followed by HS-related (56%) and anticancer treatment-related PMIs (22%). Approximately half of the PMIs (54%) were categorized as moderate interactions, and more than one-third (38%) were categorized as major interactions. Patient use of HS increased from 51% during chemotherapy to 66% after chemotherapy, and this correlated with an increased prevalence of HS PMIs (46% to 60%). HS users were more likely to be at risk for a major PMI than non-HS users (92% vs 70%; P = .038). CONCLUSIONS The use of HS remains prevalent among patients with cancer and may place them at risk for PMIs both during chemotherapy and after the completion of treatment. LAY SUMMARY This study evaluates the risk of potential medication interactions for patients with breast or prostate cancer undergoing chemotherapy. The results show that patients often use herbs and supplements during treatment. Prescription medications are most often associated with medication interactions, which are followed by herb and supplement-related interactions. More than one-third of potential medication interactions are considered major. Patients should be educated about the risk of herb and supplement-related medication interactions during treatment.
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Affiliation(s)
- Richard T Lee
- Department of Medicine, University Hospitals and Case Western Reserve University, Cleveland, Ohio
| | - Nancy Kwon
- Section of Hematology/Oncology, Department of Medicine, Northwestern University, Chicago, Illinois
| | - Jimin Wu
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Connie To
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Steven To
- Department of Palliative, Rehabilitation, and Integrative Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Russell Szmulewitz
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | | | - Holly M Holmes
- Department of Internal Medicine, University of Texas, Houston, Texas
| | - Olufunmilayo I Olopade
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Walter M Stadler
- Section of Hematology/Oncology, Department of Medicine, University of Chicago, Chicago, Illinois
| | - Jamie Von Roenn
- Section of Hematology/Oncology, Department of Medicine, Northwestern University, Chicago, Illinois
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14
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Braal CL, Hussaarts KGAM, Seuren L, Oomen-de Hoop E, de Bruijn P, Buck SAJ, Bos MEMM, Thijs-Visser MF, Zuetenhorst HJM, Mathijssen-van Stein D, Vastbinder MB, van Leeuwen RWF, van Gelder T, Koolen SLW, Jager A, Mathijssen RHJ. Influence of green tea consumption on endoxifen steady-state concentration in breast cancer patients treated with tamoxifen. Breast Cancer Res Treat 2020; 184:107-113. [PMID: 32803636 PMCID: PMC7595994 DOI: 10.1007/s10549-020-05829-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 07/20/2020] [Indexed: 12/16/2022]
Abstract
Background Many cancer patients use additional herbs or supplements in combination with their anti-cancer therapy. Green tea—active ingredient epigallocatechin-3-gallate (EGCG)—is one of the most commonly used dietary supplements among breast cancer patients. EGCG may alter the metabolism of tamoxifen. Therefore, the aim of this study was to investigate the influence of green tea supplements on the pharmacokinetics of endoxifen; the most relevant active metabolite of tamoxifen. Methods In this single-center, randomized cross-over trial, effects of green tea capsules on endoxifen levels were evaluated. Patients treated with tamoxifen for at least 3 months were eligible for this study. After inclusion, patients were consecutively treated with tamoxifen monotherapy for 28 days and in combination with green tea supplements (1 g twice daily; containing 300 mg EGCG) for 14 days (or vice versa). Blood samples were collected on the last day of monotherapy or combination therapy. Area under the curve (AUC0–24h), maximum concentration (Cmax) and minimum concentration (Ctrough) were obtained from individual plasma concentration–time curves. Results No difference was found in geometric mean endoxifen AUC0–24h in the period with green tea versus tamoxifen monotherapy (− 0.4%; 95% CI − 8.6 to 8.5%; p = 0.92). Furthermore, no differences in Cmax (− 2.8%; − 10.6 to 5.6%; p = 0.47) nor Ctrough (1.2%; − 7.3 to 10.5%; p = 0.77) were found. Moreover, no severe toxicity was reported during the whole study period. Conclusions This study demonstrated the absence of a pharmacokinetic interaction between green tea supplements and tamoxifen. Therefore, the use of green tea by patients with tamoxifen does not have to be discouraged.
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Affiliation(s)
- C Louwrens Braal
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, CN, PO Box 2040, 3015, Rotterdam, The Netherlands.
| | - Koen G A M Hussaarts
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, CN, PO Box 2040, 3015, Rotterdam, The Netherlands
| | - Lieke Seuren
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, CN, PO Box 2040, 3015, Rotterdam, The Netherlands
| | - Esther Oomen-de Hoop
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, CN, PO Box 2040, 3015, Rotterdam, The Netherlands
| | - Peter de Bruijn
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, CN, PO Box 2040, 3015, Rotterdam, The Netherlands
| | - Stefan A J Buck
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, CN, PO Box 2040, 3015, Rotterdam, The Netherlands
| | - Monique E M M Bos
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, CN, PO Box 2040, 3015, Rotterdam, The Netherlands
| | | | | | | | - Mijntje B Vastbinder
- Department of Internal Medicine, IJsselland Hospital, Capelle aan den IJssel, The Netherlands
| | - Roelof W F van Leeuwen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, CN, PO Box 2040, 3015, Rotterdam, The Netherlands.,Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Teun van Gelder
- Department of Clinical Pharmacy and Toxicology, Leiden University Medical Center, Leiden, The Netherlands
| | - Stijn L W Koolen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, CN, PO Box 2040, 3015, Rotterdam, The Netherlands.,Department of Hospital Pharmacy, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Agnes Jager
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, CN, PO Box 2040, 3015, Rotterdam, The Netherlands
| | - Ron H J Mathijssen
- Department of Medical Oncology, Erasmus MC Cancer Institute, Dr. Molewaterplein 40, CN, PO Box 2040, 3015, Rotterdam, The Netherlands
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15
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Laurent V, Saillard J, Thierry M, Lepelletier A, Fronteau C, Huon JF. Anticancer agents and phytotherapy: Interactions that are often unrecognized. J Oncol Pharm Pract 2020; 27:322-328. [PMID: 32356688 DOI: 10.1177/1078155220920363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Phytotherapy is the main complementary medicine for which patients afflicted with cancer have recourse but the associated consumption of phytotherapy products gives rise to a risk of interaction with anticancer agents. The aim of this prospective study was to measure the prevalence of the consumption of phytotherapy products as well as their interactions with anticancer agents in a cohort of patients from January 2018 to August 2019. Patients hospitalized in the conventional hematology unit and outpatients who had their prescriptions for oral anticancer agents filled at the hospital pharmacy were questioned about consumption of phytotherapy products by pharmacy externs trained in pharmaceutical interviews. Among the 110 hospitalized patients who answered the questionnaire, 40% (n = 44) used phytotherapy and 5 of them continued to consume it during the cycles of injectable chemotherapy. As a result, 10 interactions were found between the plants and the anticancer agents (prevalence of 27%). Among the 59 outpatients, 17% (n = 10) consumed phytotherapy. Eight interactions were identified (prevalence of 80%). The potential consequences were an increase or a decrease in the concentration of the anticancer agents and an increase in the risk of bleeding, hepatoxicity, and hypokalemia. The consumption of phytotherapy was unknown by a health professional for 44% of hospitalized patients and 60% of the outpatients. The risk of interactions between plants and anticancer agents is not negligible and professionals should be cognizant of this in their daily practice. The availability of tools for training and detection of interactions is indispensable for managing patients undergoing onco-hematology treatments.
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Affiliation(s)
- Vanille Laurent
- 26922CHU Nantes, Nantes, France *Vanille Laurent and Justine Saillard are co-first authors
| | - Justine Saillard
- 26922CHU Nantes, Nantes, France *Vanille Laurent and Justine Saillard are co-first authors
| | - Margot Thierry
- 26922CHU Nantes, Nantes, France *Vanille Laurent and Justine Saillard are co-first authors
| | - Aline Lepelletier
- 26922CHU Nantes, Nantes, France *Vanille Laurent and Justine Saillard are co-first authors
| | - Clémentine Fronteau
- 26922CHU Nantes, Nantes, France *Vanille Laurent and Justine Saillard are co-first authors
| | - Jean-François Huon
- 26922CHU Nantes, Nantes, France *Vanille Laurent and Justine Saillard are co-first authors
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16
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Berretta M, Rinaldi L, Taibi R, Tralongo P, Fulvi A, Montesarchio V, Madeddu G, Magistri P, Bimonte S, Trovò M, Gnagnarella P, Cuomo A, Cascella M, Lleshi A, Nasti G, Facchini S, Fiorica F, Di Francia R, Nunnari G, Pellicanò GF, Guglielmino A, Danova M, Rossetti S, Amore A, Crispo A, Facchini G. Physician Attitudes and Perceptions of Complementary and Alternative Medicine (CAM): A Multicentre Italian Study. Front Oncol 2020; 10:594. [PMID: 32411599 PMCID: PMC7202223 DOI: 10.3389/fonc.2020.00594] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 03/31/2020] [Indexed: 12/11/2022] Open
Abstract
Purpose: Complementary and Alternative Medicine (CAM) interventions are widely used by patients with chronic disorders, including cancer, and may interact with cancer treatment. Physicians are often unaware of this, probably due to poor patient-physician communication on CAM. The purpose of this study was to evaluate physicians' knowledge, attitudes and practice patterns regarding CAM in a survey conducted in Italy. Methods: A questionnaire was administered to 438 physicians (11 Italian hospitals) who predominantly treat patients with chronic disease, to collect personal and professional data and information on attitudes toward CAM and its possible role in Conventional Medicine (CM). Results: Of the 438 participants, most were specialists in oncology (18%), internal medicine (17%), surgery (15%), and radiotherapy (11%). Most worked at university (44%) or research hospitals (31%). Forty-two percent of participants believed that CAM could have an integrative role within CM. Oncologists were the physicians who were best informed on CAM (58%). Physicians working at research institutes or university hospitals had a greater knowledge of CAM than those employed at general hospitals (p < 0.0001), and those who were also involved in research activity had a greater knowledge of CAM than those who were not (p < 0.003). Length of work experience was significantly related to CAM knowledge. Moreover, 55% of participants suggest CAM interventions to their patients and 44% discuss CAM with them. The best-known interventions were acupuncture, Aloe vera and high-dose vitamin C. Conclusion: CAM use by patients with chronic disease and/or cancer has become a topical issue for the scientific community and for physicians. Knowing the reasons that prompt these patients to use CAM and guiding them in their decisions would improve treatment and outcomes and also benefit healthcare systems. Our findings contribute to a greater understanding of CAM knowledge, attitudes, and practice among Italian physicians. Further research is needed to identify the more effective CAM treatments and to work toward an integrated healthcare model.
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Affiliation(s)
- Massimiliano Berretta
- Department of Medical Oncology, Istituto Nazionale Tumori, IRCCS - CRO, Aviano (PN), Italy
| | - Luca Rinaldi
- Department of Advanced Medical and Surgical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Rosaria Taibi
- Department of Medical Oncology, Istituto Nazionale Tumori, IRCCS - CRO, Aviano (PN), Italy
| | - Paolo Tralongo
- Division of Medical Oncology, "Umberto I" Hospital, Siracusa, Italy
| | - Alberto Fulvi
- Division of Medical Oncology, "Gemelli" Hospital, Roman, Italy
| | | | - Giordano Madeddu
- Division of Infectious Diseases, University of Sassari, Sassari, Italy
| | - Paolo Magistri
- Department of Surgery, University of Modena and Reggio Emilia, Modena, Italy
| | - Sabrina Bimonte
- Department of Anaesthesia and Pain Medicine, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy
| | - Marco Trovò
- Division of Radiotherapy, "Santa Maria della Misericordia" Hospital, Udine, Italy
| | - Patrizia Gnagnarella
- Division of Epidemiology and Biostatistics IEO European Institute of Oncology IRCCS, Milan, Italy
| | - Arturo Cuomo
- Department of Anaesthesia and Pain Medicine, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy
| | - Marco Cascella
- Department of Anaesthesia and Pain Medicine, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy
| | - Arben Lleshi
- Department of Medical Oncology, Istituto Nazionale Tumori, IRCCS - CRO, Aviano (PN), Italy
| | - Guglielmo Nasti
- Division of Medical Oncology B, Istituto Nazionale Tumori "Fondazione G. Pascale" IRCCS, Naples, Italy
| | - Sergio Facchini
- Department of Urology, University of Naples "Federico II", Naples, Italy
| | | | | | - Giuseppe Nunnari
- Division of Infectious Disease, University of Messina, Messina, Italy
| | | | - Aurelio Guglielmino
- Division of Anaesthesia, Policlinico Universitario, University of Catania, Catania, Italy
| | - Marco Danova
- Department of Internal Medicine and Medical Oncology, Vigevano Civic Hospital, ASST of Pavia, Vigevano, Italy
| | - Sabrina Rossetti
- Medical Oncology, Department of Uro-Gynaecological Oncology 'Istituto Nazionale Tumori' 'Fondazione G. Pascale' IRCCS, Naples, Italy
| | - Alfonso Amore
- Division of Surgery Melanoma and Skin Cancer, 'Istituto Nazionale Tumori' 'Fondazione G. Pascale' IRCCS, Naples, Italy
| | - Anna Crispo
- Unit of Epidemiology, 'Istituto Nazionale Tumori' 'Fondazione G. Pascale' IRCCS, Naples, Italy
| | - Gaetano Facchini
- Medical Oncology, Department of Uro-Gynaecological Oncology 'Istituto Nazionale Tumori' 'Fondazione G. Pascale' IRCCS, Naples, Italy
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Hagoel L, Vexler A, Kalich-Philosoph L, Earon G, Ron I, Shtabsky A, Marmor S, Lev-Ari S. Combined Effect of Moringa oleifera and Ionizing Radiation on Survival and Metastatic Activity of Pancreatic Cancer Cells. Integr Cancer Ther 2019; 18:1534735419828829. [PMID: 30862207 PMCID: PMC6416749 DOI: 10.1177/1534735419828829] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Background: Radiotherapy is one of the main treatments for
malignancies. Radioresistance is a major obstacle in this treatment, calling for
new treatments to improve radiotherapy outcome. Herbal medicine has low toxicity
and could be a source for new radio-enhancing agents. Moringa
oleifera (moringa) is a well-known medicinal plant with
antiproliferative and antimetastatic properties. Possible mechanisms of moringa
anticancer activity may be related to the expression of PARP-1, Bcl-2, COX-2,
p65, p-IκB-a, and others. Purpose: The aims of the present study
were to investigate effect of moringa alone and combined with radiation on
survival and metastatic activity of pancreatic cancer cells and on tumor growth.
Methods and Results: The combination of moringa and radiation
significantly inhibited PANC-1 cell survival in a dose-dependent manner, as
tested by clonogenic and XTT assays. Moreover, standard transwell cell
migration/invasion assays demonstrated reduced metastatic activity of these
cells. Pyruvate mitigated the inhibitory effect of combined treatment on cell
survival. Flow cytometry of moringa-treated cells revealed induction of
apoptosis. Western blot analysis found that the combined treatment decreased
expression of the pro-apoptotic protein Bcl-2, and downregulated the key
component of DNA repair pathways PARP-1 and the NF-κB-related proteins IκB-α,
p65-subunit, and COX-2. Moringa significantly inhibited growth of subcutaneous
tumors generated by PANC-1 cells in nude mice. Immunohistochemical analysis
demonstrated moringa’s antiproliferative and antiangiogenic effects.
Conclusions: Moringa decreased pancreatic cancer cell survival
and metastatic activity and significantly inhibited tumor growth. The
combination of moringa plus radiation resulted in an additional inhibitory
effect that provided the rationale for further investigation of this combination
as a novel strategy to overcome pancreatic cancer cell radioresistance.
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Affiliation(s)
- Lior Hagoel
- 1 Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Akiva Vexler
- 1 Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | - Gideon Earon
- 1 Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Ilan Ron
- 1 Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Alex Shtabsky
- 1 Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Silvia Marmor
- 1 Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
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A Systematic Review of Drug Metabolism Studies of Plants With Anticancer Properties: Approaches Applied and Limitations. Eur J Drug Metab Pharmacokinet 2019; 45:173-225. [DOI: 10.1007/s13318-019-00582-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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19
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Danggui Buxue Decoction Sensitizes the Response of Non-Small-Cell Lung Cancer to Gemcitabine via Regulating Deoxycytidine Kinase and P-glycoprotein. Molecules 2019; 24:molecules24102011. [PMID: 31130654 PMCID: PMC6572355 DOI: 10.3390/molecules24102011] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2019] [Revised: 05/11/2019] [Accepted: 05/24/2019] [Indexed: 02/07/2023] Open
Abstract
This study aimed to investigate whether the anti-tumor effect of gemcitabine (GEM) in non-small-cell lung cancer (NSCLC) treatment was affected by Danggui Buxue decoction (DBD), and explore the potential mechanisms. The combined use of GEM and DBD showed an enhanced tumor growth inhibition effect in a murine Lewis lung carcinoma (LLC) model. LC-MS/MS results showed that the pharmacokinetic behaviors of a GEM active metabolite, gemcitabine triphosphate (dFdCTP), were found to be altered remarkably in the peripheral blood mononuclear cells (PBMC) of DBD co-administration rats. In addition, after co-administration of DBD with GEM, Western Blot and qPCR results confirmed that the expression of deoxycytidine kinase (dCK) in tumor tissues of LLC-bearing mice were markedly increased. DBD co-administration also reversed the upregulation of P-glycoprotein (P-gp) in tumor tissues induced by GEM. Moreover, DBD could notably up-regulate the IL-12p70 and GM-CSF expression in mice serum, suggesting potential immunomodulatory activities in tumor-bearing mice. Meanwhile, DBD inhibited the P-gp efflux activity in A549 cells. Therefore, the regulation of dCK and P-gp played important roles in the alternation of GEM pharmacokinetics and the enhancement of the anti-tumor effect of GEM. DBD being a potential dCK promoter could work as an adjuvant agent to boost the anticancer effect of GEM.
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20
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Albassam AA, Frye RF. Effect of pterostilbene on in vitro drug metabolizing enzyme activity. Saudi Pharm J 2019; 27:406-412. [PMID: 30976185 PMCID: PMC6438784 DOI: 10.1016/j.jsps.2019.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 01/05/2019] [Indexed: 01/14/2023] Open
Abstract
Pterostilbene is a natural polyphenol compound found in small berries that is related to resveratrol, but has better bioavailability and a longer half-life. The purpose of this study was to assess the potential inhibitory effect of pterostilbene on in vitro drug metabolism. The effect of pterostilbene on cytochrome P450 (CYP) and UDP-glucuronosyltransferase (UGT) enzyme activities were studied using the enzyme-selective substrates amodiaquine (CYP2C8), midazolam (CYP3A4), estradiol (UGT1A1), serotonin (UGT1A6) and mycophenolic acid (UGT1A8/9/10). The IC50 value was used to express the strength of inhibition. Further, a volume per dose index (VDI) was used to estimate the potential for in vivo interactions. Pterostilbene significantly inhibited CYP2C8 and UGT1A6 activities. The IC50 (mean ± SE) values for CYP2C8 and UGT1A6 inhibition were 3.0 ± 0.4 µM and 15.1 ± 2.8 µM, respectively; the VDI exceeded the predefined threshold of 5 L/dose for both CYP2C8 and UGT1A6, suggesting a potential for interaction in vivo. Pterostilbene did not inhibit the metabolism of the other enzyme-selective substrates. The results of this study indicate that pterostilbene inhibits CYP2C8 and UTG1A6 activity in vitro and may inhibit metabolism by these enzymes in vivo. Clinical studies are warranted to evaluate the in vivo relevance of these interactions.
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Key Words
- Amodiaquine
- CYP, cytochrome P450
- CYP2C8
- DEAQ, desethylamodiaquine
- Enzyme inhibition
- HIM, human intestine microsomes
- HLM, human liver microsomes
- HPLC, high-performance liquid chromatography
- Hydroxypioglitazone
- IC50, concentration of inhibitor that results in 50% inhibition of reaction
- LC-MS/MS, liquid chromatography/tandem mass spectrometry
- M-IV, hydroxypioglitazone
- N-desethylamodiaquine
- Pioglitazone
- Pterostilbene
- RDI, recommended daily intake
- Serotonin
- Serotonin glucuronide
- UDPGA, uridine diphosphate glucuronic acid
- UGT, UDP-glucuronosyltransferase
- UGT1A6
- V/D, volume per dose index
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Affiliation(s)
- Ahmed A. Albassam
- Department of Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, Al-Kharj, Saudi Arabia
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
- Corresponding author at: Clinical Pharmacy, College of Pharmacy, Prince Sattam Bin Abdulaziz University, P.O. Box 173, Al-Kharj 11942, Saudi Arabia.
| | - Reginald F. Frye
- Department of Pharmacotherapy and Translational Research, College of Pharmacy, University of Florida, Gainesville, FL, USA
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21
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Zick SM, Czuhajewski C, Fouladbakhsh JM, Greenlee H, Harris RE, Henry NL, Jolly S, Khabir T, Perlmutter J, Remington T, Snyder D, Spratke L, Zebrack B, Zettell E, Benn R. Integrative Oncology Scholars Program: A Model for Integrative Oncology Education. J Altern Complement Med 2018; 24:1018-1022. [PMID: 30247974 DOI: 10.1089/acm.2018.0184] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Oncology providers are often confronted by patients who use complementary or alternative therapies, but have limited knowledge or confidence on how to advise patients on appropriate use. Despite this, there are few opportunities for oncology providers to learn about complementary or alternative therapies, while at the same time there is a high demand for integrative oncology (IO) training. To address a gap in IO educational opportunities, and particularly for nonphysicians, we created the Integrative Oncology Scholars (IOS) Program. The program's goal is to train 100 IO leaders and facilitate partnerships between them and complementary practitioners. DESIGN Four iterations of a year-long National Cancer Institute-funded educational program that combines in-person team-based learning and eLearning to teach the evidence, application, and philosophy supporting IO. SETTINGS In-person sessions take place at the University of Michigan, and eLearning is implemented using a Canvas website (Instructure, Inc., Salt Lake City, UT). SUBJECTS Nurses, social workers, physician assistants, psychologists, physicians, pharmacists, and physical/occupational therapists with active oncology practices. Educational intervention: Four cohorts of 25 oncology providers per year will learn the evidence base for complementary and alternative approaches to a wide number of oncology topics, including symptom control, dietary supplements commonly used by cancer patients, diet, and the utility of specific integrative approaches for common oncology side-effects such as fatigue. OUTCOME MEASURES A mixed methods approach will be used to evaluate overall IOS Program progress and individual scholar's impact on IO research, education, and clinical endeavors. RESULTS The first cohort of 25 IOS has been recruited and their education will begin in Summer 2018. Scholars come from 13 states and represent 23 different healthcare systems. CONCLUSIONS The IOS Program has the potential to increase the number of trained IO providers, educators, and researchers in the United States.
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Affiliation(s)
- Suzanna Maria Zick
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan.,2 Department of Nutritional Sciences, University of Michigan , Ann Arbor, Michigan
| | | | | | - Heather Greenlee
- 4 Department of Medical Oncology, Fred Hutchinson Cancer Research Center , Seattle, Washington
| | | | - Norah Lynn Henry
- 5 Department of Internal Medicine, University of Utah , Salt Lake City, Utah
| | - Shruti Jolly
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
| | - Tohfa Khabir
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
| | | | - Tami Remington
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
| | - Detrick Snyder
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
| | - Lisa Spratke
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
| | - Brad Zebrack
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
| | - Erin Zettell
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
| | - Rita Benn
- 1 Department of Family Medicine, University of Michigan , Ann Arbor, Michigan
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22
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Luo Q, Asher GN. Use of Dietary Supplements at a Comprehensive Cancer Center. J Altern Complement Med 2018; 24:981-987. [DOI: 10.1089/acm.2018.0183] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Affiliation(s)
- Qianlai Luo
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Gary N. Asher
- Department of Family Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Integrative Medicine Services, UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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23
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Yang G, Zhang H, Gan Z, Fan Y, Gu W, Ling C. Discrepant Views of Oncologists and Cancer Patients on Complementary and Alternative Medicine in a Chinese General Hospital. Integr Cancer Ther 2018; 17:451-457. [PMID: 28870099 PMCID: PMC6041901 DOI: 10.1177/1534735417725579] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Revised: 06/14/2017] [Accepted: 07/03/2017] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Complementary and alternative medicine (CAM) has been widely used by cancer patients but rarely discussed by oncologists. This study was designed to evaluate the communication gap between China's oncologists and cancer patients on CAM. METHODS Two parallel cross-sectional studies assessed 83 oncologists and 402 cancer patients on CAM communication between patients and oncologists, and attitudes toward CAM use and clinical decisions about CAM. RESULTS A majority (75.1%) of the cancer patients (302/402) were identified as CAM users within the most recent three months while 77.6% of the cancer patients (312/402) were identified as CAM users since diagnosis of cancer. Oncologists and patients responded differently ( P < .001) on CAM communications. Both oncologists and patients expected that CAM could improve the immune system. They both agreed that oncologists usually discouraged their patients from using CAM. Regarding the effectiveness of CAM, cancer patients were more likely to believe that CAM was effective while oncologists had more concerns about adverse effects of CAM use. CAM use by patients was predicted by disease duration (≥9 months) in the multivariable logistic regression model. CONCLUSION China's oncologists and cancer patients may hold discrepant views on CAM. China's oncologists are encouraged to improve their knowledge on CAM and to initiate more discussions with their patients regarding effective and the safe use of CAM.
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Affiliation(s)
- Geliang Yang
- Changhai Hospital of Traditional Chinese Medicine, Second Military Medical University, Shanghai, China
| | - Huiqing Zhang
- Changhai Hospital of Traditional Chinese Medicine, Second Military Medical University, Shanghai, China
| | - Zheng Gan
- Changhai Hospital of Traditional Chinese Medicine, Second Military Medical University, Shanghai, China
| | - Yifu Fan
- Changhai Hospital of Traditional Chinese Medicine, Second Military Medical University, Shanghai, China
| | - Wei Gu
- Changhai Hospital of Traditional Chinese Medicine, Second Military Medical University, Shanghai, China
| | - Changquan Ling
- Changhai Hospital of Traditional Chinese Medicine, Second Military Medical University, Shanghai, China
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24
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Zhai J, Zhang F, Gao S, Chen L, Feng G, Yin J, Chen W. Schisandra chinensis extract decreases chloroacetaldehyde production in rats and attenuates cyclophosphamide toxicity in liver, kidney and brain. JOURNAL OF ETHNOPHARMACOLOGY 2018; 210:223-231. [PMID: 28821392 DOI: 10.1016/j.jep.2017.08.020] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 07/24/2017] [Accepted: 08/14/2017] [Indexed: 06/07/2023]
Abstract
ETHNOPHARMACOLOGICAL RELEVANCE Schisandra chinensis (Turcz.) Baill (S. chinensis) has been used for thousands years in China, and is usually applied in treatment of urinary tract disorders and liver injury. S. chinensis extract (SCE) has board protective effects on liver, kidney and nervous system. Schisandra lignans are generally considered as the bioactive components of SCE. AIM OF THE STUDY To investigate the pharmacokinetic herb-drug interactions (HDIs) between SCE and cyclophosphamide (CTX). To evaluate the protective effects of SCE against CTX induced damage in rat liver, kidney and brain. MATERIALS AND METHODS The pharmacokinetic HDIs between SCE and CTX were investigated by determining plasma concentrations of CTX and three metabolites, namely 4-ketocyclophosphamide (4-Keto), 2-dechloroethylcyclophosphamide (DCCTX) and carboxyphosphamide (CPM) using a previously developed UPLC-MS/MS method. To evaluate the protective effects of SCE pretreatment, toxicity and oxidation stress assessments along with histology investigations were carried out in rat liver, kidney and brain. RESULTS The equimolar produced metabolite DCCTX was chosen to reflect chloroacetaldehyde (CAA, a toxic metabolite of CTX) production in rats. Single-dose pretreatment of SCE significantly reduced CAA production and decreased the Cmax and AUC0-24h of DCCTX by 69% and 49% respectively (P < 0.05). After pretreated with SCE for 7 consecutive days, the Cmax and AUC0-24h of DCCTX were still decreased (-25% and -37%, P < 0.05) when compared with CTX alone group. Parallel toxicity and oxidation stress investigations showed that single-dose SCE pretreatment significantly decreased plasma BUN and Cr levels (-12% and -46%, respectively) and reduced liver AST activity (-32%). Moreover, SCE pretreatment potently increased the brain GSH content by 7.8-fold, and reduced MDA levels in rat liver, kidney and brain by 39%, 28% and 31%, respectively (compared with CTX alone group). The protective effects of SCE were also supported by histological observations. CONCLUSION Our experiment results suggest that S. chinensis may find use as a complementary medicine in CTX treatment.
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Affiliation(s)
- Jianxiu Zhai
- School of Traditional Chinese Material, Shenyang Pharmaceutical University, Shenyang, China; Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Feng Zhang
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Shouhong Gao
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, China.
| | - Li Chen
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, China; Key Laboratory of Jiangxi Province for Research on Active Ingredients in Natural Medicines, Bioengineering Research Institute, Yichun University, Yichun, China.
| | - Ge Feng
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, China; Key Laboratory of Jiangxi Province for Research on Active Ingredients in Natural Medicines, Bioengineering Research Institute, Yichun University, Yichun, China.
| | - Jun Yin
- School of Traditional Chinese Material, Shenyang Pharmaceutical University, Shenyang, China.
| | - Wansheng Chen
- Department of Pharmacy, Changzheng Hospital, Second Military Medical University, Shanghai, China.
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25
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Pourroy B, Letellier C, Helvig A, Chanet B, De Crozals F, Alessandra C. Development of a rapid risk evaluation tool for herbs/drugs interactions in cancer patients: a multicentric experience in south of France. Eur J Cancer Care (Engl) 2017; 26. [DOI: 10.1111/ecc.12752] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2017] [Indexed: 10/18/2022]
Affiliation(s)
- B. Pourroy
- Oncopharma Unit; Department of Pharmacy; La Timone University Teaching Hospital; Marseille France
| | - C. Letellier
- Department of Pharmacy; Clairval Private Hospital; Marseille France
| | - A. Helvig
- Department of Pharmacy; Paoli Calmettes Cancer Center; Marseille France
| | - B. Chanet
- Department of Pharmacy; Sainte Catherine Cancer Center; Avignon France
| | - F. De Crozals
- Department of Pharmacy; Sainte Catherine Cancer Center; Avignon France
| | - C. Alessandra
- Department of Pharmacy; Sainte Musse Intercommunal Hospital Center; Toulon France
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26
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Alsanad SM, Howard RL, Williamson EM. An assessment of the impact of herb-drug combinations used by cancer patients. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 16:393. [PMID: 27756298 PMCID: PMC5070090 DOI: 10.1186/s12906-016-1372-x] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 10/12/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Herb/Dietary Supplements (HDS) are the most popular Complementary and Alternative Medicine (CAM) modality used by cancer patients and the only type which involves the ingestion of substances which may interfere with the efficacy and safety of conventional medicines. This study aimed to assess the level of use of HDS in cancer patients undergoing treatment in the UK, and their perceptions of their effects, using 127 case histories of patients who were taking HDS. Previous studies have evaluated the risks of interactions between HDS and conventional drugs on the basis on numbers of patient using HDSs, so our study aimed to further this exploration by examining the actual drug combinations taken by individual patients and their potential safety. METHOD Three hundred seventy-five cancer patients attending oncology departments and centres of palliative care at the Oxford University Hospitals Trust (OUH), Duchess of Kent House, Sobell House, and Nettlebed Hospice participated in a self-administered questionnaire survey about their HDS use with their prescribed medicines. The classification system of Stockley's Herbal Medicine's Interactions was adopted to assess the potential risk of herb-drug interactions for these patients. RESULTS 127/375 (34 %; 95 % CI 29, 39) consumed HDS, amounting to 101 different products. Most combinations were assessed as 'no interaction', 22 combinations were categorised as 'doubt about outcomes of use', 6 combinations as 'Potentially hazardous outcome', one combination as an interaction with 'Significant hazard', and one combination as an interaction of "Life-threatening outcome". Most patients did not report any adverse events. CONCLUSION Most of the patients sampled were not exposed to any significant risk of harm from interactions with conventional medicines, but it is not possible as yet to conclude that risks in general are over-estimated. The incidence of HDS use was also less than anticipated, and significantly less than reported in other areas, illustrating the problems when extrapolating results from one region (the UK), in one setting (NHS oncology) in where patterns of supplement use may be very different to those elsewhere.
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Singh JC, Lichtman SM. Effect of age on drug metabolism in women with breast cancer. Expert Opin Drug Metab Toxicol 2016; 11:757-66. [PMID: 25940027 DOI: 10.1517/17425255.2015.1037277] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The aging of the population will increase the number of breast cancer patients requiring treatment in both the adjuvant and metastatic setting. Hormones, chemotherapy and targeted drugs all have a role in treatment. Older patients have been underrepresented in clinical trials making evidence-based decisions difficult. The increase in comorbidity and aging, polypharmacy and changes in function make pharmacotherapy decisions more complicated. Knowledge of the issues is critical in the prescribing of effective and safe therapy. There are factors associated with advancing age that can result in pharmacokinetic and pharmacodynamic variations in processing of hormonal agents, chemotherapy and targeted drugs. AREAS COVERED A review of the literature pertaining to pharmacokinetic changes in aging in breast cancer was untaken. Studies are reviewed involving single agents and some combinations. EXPERT OPINION Older patients should be considered for standard therapies. Their specific problems need to be evaluated by geriatric-specific assessment including functional status, end organ dysfunction and polypharmacy. There are few instances for age-related changes in pharmacokinetics and when present are usually not clinically significant. When changes are present, they are often the result of comorbidity, drug interactions and drug scheduling issues. The older patients may be more sensitive to certain toxicities such as cardiac toxicity, neuropathy and myelosuppression.
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Affiliation(s)
- Jasmeet C Singh
- Memorial Sloan Kettering Cancer Center , 650 Commack Road, Commack, NY 11725 , USA +1 631 623 4100 ; +1 631 864 3827 ;
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28
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Lee RT, Barbo A, Lopez G, Melhem-Bertrandt A, Lin H, Olopade OI, Curlin FA. National survey of US oncologists' knowledge, attitudes, and practice patterns regarding herb and supplement use by patients with cancer. J Clin Oncol 2014; 32:4095-101. [PMID: 25403205 DOI: 10.1200/jco.2014.55.8676] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
PURPOSE Patients with cancer commonly use complementary and alternative medicine, including herbs and supplements (HS), during cancer treatment. This national survey explored oncologists' knowledge, attitudes, and practice patterns regarding HS use by their patients. METHODS A survey was sent by mail and e-mail to a random sample of 1,000 members of the American Society for Clinical Oncology. The questions covered several topics: communication patterns, attitudes about HS, education about HS, response to HS use among hypothetical patients with cancer, knowledge of HS adverse effects, and demographic information. RESULTS Among eligible oncologists, 392 (42%) responded to the questionnaire. Most were white (75%) men (71%), with a mean age of 48 years (standard deviation, 9.8 years). On average, oncologists discussed use of HS with 41% of their patients; only 26% of discussions were initiated by the oncologist. Two of three oncologists indicated they did not have enough knowledge to answer questions from patients regarding HS, and 59% had not received any education about the topic. Physician factors associated with having initiated discussions with patients about the use of HS included female sex, higher self-reported knowledge, prior education about HS, increased knowledge about HS adverse effects and interactions, and estimating that > 40% of one's patients with cancer use HS. CONCLUSION Fewer than one half of oncologists are initiating discussions with patients about HS use, and many indicate that lack of knowledge and education is a barrier to such discussions. Improving physician education about HS may facilitate more physician-patient communication about this important topic.
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Affiliation(s)
- Richard T Lee
- Richard T. Lee, Andrea Barbo, Gabriel Lopez, Amal Melhem-Bertrandt, and Heather Lin, University of Texas MD Anderson Cancer Center, Houston, TX; Olufunmilayo I. Olopade, University of Chicago, Chicago, IL; and Farr A. Curlin, Duke University, Durham, NC.
| | - Andrea Barbo
- Richard T. Lee, Andrea Barbo, Gabriel Lopez, Amal Melhem-Bertrandt, and Heather Lin, University of Texas MD Anderson Cancer Center, Houston, TX; Olufunmilayo I. Olopade, University of Chicago, Chicago, IL; and Farr A. Curlin, Duke University, Durham, NC
| | - Gabriel Lopez
- Richard T. Lee, Andrea Barbo, Gabriel Lopez, Amal Melhem-Bertrandt, and Heather Lin, University of Texas MD Anderson Cancer Center, Houston, TX; Olufunmilayo I. Olopade, University of Chicago, Chicago, IL; and Farr A. Curlin, Duke University, Durham, NC
| | - Amal Melhem-Bertrandt
- Richard T. Lee, Andrea Barbo, Gabriel Lopez, Amal Melhem-Bertrandt, and Heather Lin, University of Texas MD Anderson Cancer Center, Houston, TX; Olufunmilayo I. Olopade, University of Chicago, Chicago, IL; and Farr A. Curlin, Duke University, Durham, NC
| | - Heather Lin
- Richard T. Lee, Andrea Barbo, Gabriel Lopez, Amal Melhem-Bertrandt, and Heather Lin, University of Texas MD Anderson Cancer Center, Houston, TX; Olufunmilayo I. Olopade, University of Chicago, Chicago, IL; and Farr A. Curlin, Duke University, Durham, NC
| | - Olufunmilayo I Olopade
- Richard T. Lee, Andrea Barbo, Gabriel Lopez, Amal Melhem-Bertrandt, and Heather Lin, University of Texas MD Anderson Cancer Center, Houston, TX; Olufunmilayo I. Olopade, University of Chicago, Chicago, IL; and Farr A. Curlin, Duke University, Durham, NC
| | - Farr A Curlin
- Richard T. Lee, Andrea Barbo, Gabriel Lopez, Amal Melhem-Bertrandt, and Heather Lin, University of Texas MD Anderson Cancer Center, Houston, TX; Olufunmilayo I. Olopade, University of Chicago, Chicago, IL; and Farr A. Curlin, Duke University, Durham, NC
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Alsanad SM, Williamson EM, Howard RL. Cancer Patients at Risk of Herb/Food Supplement-Drug Interactions: A Systematic Review. Phytother Res 2014; 28:1749-55. [DOI: 10.1002/ptr.5213] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 07/16/2014] [Accepted: 07/23/2014] [Indexed: 01/13/2023]
Affiliation(s)
- Saud M. Alsanad
- School of Pharmacy; University of Reading; Whitekights Reading RG6 6AP UK
| | | | - Rachel L. Howard
- School of Pharmacy; University of Reading; Whitekights Reading RG6 6AP UK
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Dufay S, Worsley A, Monteillier A, Avanzi C, Sy J, Ng TF, Garcia JM, Lam MF, Vanhoutte P, Wong ICK. Herbal tea extracts inhibit Cytochrome P450 3A4 in vitro. ACTA ACUST UNITED AC 2014; 66:1478-90. [PMID: 24824478 DOI: 10.1111/jphp.12270] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 03/23/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVES Ciclosporin and sirolimus, two immunosuppressive agents with narrow therapeutic windows, are mainly metabolized by Cytochrome 3A4 (CYP3A4). A clinical case of toxic blood levels of these drugs after the consumption of a '24-flavours' tea was reported. This study aims to identify the causative ingredients of the 24-flavour herbal tea in the inhibition of CYP3A4 metabolism. METHODS Two commercially available 24-flavour tea products purchased in Hong Kong and the six plant constituents were tested for their CYP3A4 inhibitory effects utilizing an in-vitro fluorometric assay. KEY FINDINGS Of the commercially available teas available in Hong Kong, the most potent inhibitory effect was observed with the tea consumed in the initial clinical case. Of the six universal constituents, chrysanthemum exhibited the greatest inhibitory effect, with an IC50 of 95.7 μg/ml. Dandelion, liquorice and bishop's weed have IC50 of 140.6, 148.4 and 185.5 μg/ml, respectively. Field mint and Japanese honeysuckle have weaker inhibitory effect on CYP3A4 with IC50 of 1153.3 and 1466.3 μg/ml. CONCLUSIONS This study confirms the possible implication of herbal tea constituents in the inhibition of ciclosporin and sirolimus' CYP3A4 metabolism. Combined usage of herbal teas with drug should be closely monitored.
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Affiliation(s)
- Sophie Dufay
- Department of Pharmacology and Pharmacy, The University of Hong Kong, Hong Kong
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Almog L, Lev E, Schiff E, Linn S, Ben-Arye E. Bridging cross-cultural gaps: monitoring herbal use during chemotherapy in patients referred to integrative medicine consultation in Israel. Support Care Cancer 2014; 22:2793-804. [PMID: 24817575 DOI: 10.1007/s00520-014-2261-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 04/22/2014] [Indexed: 12/28/2022]
Abstract
INTRODUCTION The high prevalence of the use of traditional herbs among patients with cancer is a cause for concern with regard to potentially adverse interactions with conventional oncology treatments. In this study, we explore herbal use among patients with cancer in northern Israel who are referred by their health care providers to complementary and traditional medicine (CTM) consultations provided to them within the conventional oncology department. The study's objectives were to identify which herbs patients use and to examine the scope of current research on the efficacy and safety regarding the identified herbs. PATIENTS AND METHODS Herbal use by patients receiving oncology care was assessed prospectively from July 2009 to July 2012 by integrative physicians (IPs) trained in herbal medicine. Historical, ethnobotanical, basic research, and clinical data regarding the identified herbs were explored by using a keyword search in PubMed and Middle Eastern ethnohistorical literature. RESULTS Disclosure of herbal use was reported by 154 of the 305 patients (50.5 %) interviewed by IPs. The use of 85 single herbs and 30 different herbal formulas was documented during the initial or follow-up IP assessments. Patients reported 14 quality of life-associated indications for herbal use. The ten most prevalent herbs displaying in vitro/in vivo anticancer activity and nine other herbs were preliminarily assessed concerning potential risks, safety, and interaction with chemotherapy. CONCLUSIONS Herbal use by patients with cancer in northern Israel is widespread and calls for further study in order to address issues of safety and effectiveness. We recommend constructing a multinational and multidisciplinary team of researchers with ethnopharmacological and clinical expertise that will explore the use of herbs among patients with cancer in a cross-cultural perspective attuned with patients' affinity to traditional herbal medicine.
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Affiliation(s)
- Limor Almog
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, 35 Rothschild St., Haifa and Western Galilee District, Haifa, Israel
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Goey AKL, Meijerman I, Rosing H, Burgers JA, Mergui-Roelvink M, Keessen M, Marchetti S, Beijnen JH, Schellens JHM. The effect of Echinacea purpurea on the pharmacokinetics of docetaxel. Br J Clin Pharmacol 2014; 76:467-74. [PMID: 23701184 DOI: 10.1111/bcp.12159] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Accepted: 05/10/2013] [Indexed: 12/13/2022] Open
Abstract
AIMS The herbal medicine Echinacea purpurea (E. purpurea) has been shown to induce cytochrome P450 3A4 (CYP3A4) both in vitro and in humans. This study explored whether E. purpurea affects the pharmacokinetics of the CYP3A4 substrate docetaxel in cancer patients. METHODS Ten evaluable cancer patients received docetaxel (135 mg, 60 min IV infusion) before intake of a commercially available E. purpurea extract (20 oral drops three times daily) and 3 weeks later after a 14 day supplementation period with E. purpurea. In both cycles, pharmacokinetic parameters of docetaxel were determined. RESULTS Before and after supplementation with E. purpurea, the mean area under the plasma concentration-time curve of docetaxel was 3278 ± 1086 and 3480 ± 1285 ng ml(-1) h, respectively. This result was statistically not significant. Nonsignificant alterations were also observed for the elimination half-life (from 30.8 ± 19.7 to 25.6 ± 5.9 h, P = 0.56) and maximum plasma concentration of docetaxel (from 2224 ± 609 to 2097 ± 925 ng ml(-1) , P = 0.30). CONCLUSIONS The multiple treatment of E. purpurea did not significantly alter the pharmacokinetics of docetaxel in this study. The applied E. purpurea product at the recommended dose may be combined safely with docetaxel in cancer patients.
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Affiliation(s)
- Andrew K L Goey
- Department of Pharmaceutical Sciences, Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht, The Netherlands
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Wang Z, Xia Q, Cui J, Diao Y, Li J. Reversion of P-glycoprotein-mediated multidrug resistance by diallyl trisulfide in a human osteosarcoma cell line. Oncol Rep 2014; 31:2720-6. [PMID: 24788927 DOI: 10.3892/or.2014.3154] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 04/11/2014] [Indexed: 11/06/2022] Open
Abstract
Diallyl trisulfide (DATS), the main sulfuric compound in garlic, has been shown to have antitumor effects. The present study aimed to ascertain whether DATS reverses the drug resistance of human osteosarcoma cells in vitro and to investigate its potential mechanisms. Human osteosarcoma U2-OS cells were treated with different concentrations of DATS. Cell proliferation was measured by 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) assay, while P-glycoprotein (P-gp) expression and the proportion of apoptotic cells were measured by flow cytometry. Morphological changes were observed under an optical microscope. Νuclear factor-κB (NF-κB) and inhibitor of NF-κB (IκB) activities were measured by PCR and western blot analysis. Results showed that the proliferation of U2-OS cells treated with different concentrations of DATS was significantly decreased in a concentration- and time-dependent manner. DATS increased the toxic effect of adriamycin on U2-OS cells. Moreover, P-gp expression was decreased and the apoptosis rate was increased in a concentration-dependent manner following treatment of DATS. Additionally, NF-κB activity was inhibited by DATS while expression of IκB was increased. Our data clearly suggest that DATS has significant anticancer effects on human osteosarcoma cells. The potential mechanisms include reducing the multidrug resistance and inducing apoptosis. NF-κB suppression may be involved in DATS-induced inhibition of cell proliferation.
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Affiliation(s)
- Zhiyong Wang
- Department of Emergency Surgery, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Qing Xia
- Department of Urinary Medicine, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
| | - Jia Cui
- Shouguang Centre for Disease Control and Prevention, Shouguang, Shandong 262700, P.R. China
| | - Yutao Diao
- Institute of Basic Medicine, Shandong Academy of Medical Sciences, Jinan, Shandong 250062, P.R. China
| | - Jianmin Li
- Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong 250012, P.R. China
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Koehl B, Muenstedt K, Micke O, Muecke R, Buentzel J, Stoll C, Prott FJ, Dennert G, Senf B, Huebner J. Survey of German Non-Medical Practitioners Regarding Complementary and Alternative Medicine in Oncology. Oncol Res Treat 2014; 37:49-53. [DOI: 10.1159/000358158] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2013] [Accepted: 12/03/2013] [Indexed: 11/19/2022]
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Patil D, Gautam M, Gairola S, Jadhav S, Patwardhan B. Effect of Botanical Immunomodulators on Human CYP3A4 Inhibition. Integr Cancer Ther 2013; 13:167-75. [DOI: 10.1177/1534735413503551] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose. Many botanical immunomodulators are used as adjuvants along with cancer chemotherapy. However, information on the impact of concurrent administration of such botanicals on pharmacokinetics of chemotherapy agents is inadequate. This study investigates inhibitory activities of 3 popular botanical adjuvants: Asparagus racemosus (root aqueous extract; ARE), Withania somnifera (root aqueous extract; WSE), and Tinospora cordifolia (stem aqueous extract, TCE) on human CYP3A4 isoenzyme, responsible for metabolism of several chemotherapy agents. Experimental design. Testosterone 6-β hydroxylation was monitored using high-performance liquid chromatography as an indicator of CYP3A4 catalytic activities. Ketoconazole (positive control) and extracts were studied at their in vivo–relevant concentrations. Results. TCE showed mild inhibition while no significant inhibitory activities were observed in WSE and ARE. TCE was further fractionated to obtain polar and nonpolar fractions. The nonpolar fraction showed significant CYP3A4 inhibition with IC50 13.06 ± 1.38 µg/mL. Major constituents of nonpolar fraction were identified using HPLC-DAD-MS profiling as berberine, jatrorrhizine, and palmatine, which showed IC50 values as 6.25 ± 0.30, 15.18 ± 1.59, and 15.53 ± 1.89 µg/mL, respectively. Conclusion. Our findings suggest that constituents of TCE extract especially protoberberine alkaloids have the potential to interact with cancer chemotherapy agents that are metabolized by CYP3A4 in vivo.
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Affiliation(s)
- Dada Patil
- Serum Institute of India Research Foundation, Hadapsar, Pune, India
| | - Manish Gautam
- Serum Institute of India Research Foundation, Hadapsar, Pune, India
| | - Sunil Gairola
- Serum Institute of India Limited, Hadapsar, Pune, India
| | - Suresh Jadhav
- Serum Institute of India Limited, Hadapsar, Pune, India
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Berkovich L, Earon G, Ron I, Rimmon A, Vexler A, Lev-Ari S. Moringa Oleifera aqueous leaf extract down-regulates nuclear factor-kappaB and increases cytotoxic effect of chemotherapy in pancreatic cancer cells. BMC COMPLEMENTARY AND ALTERNATIVE MEDICINE 2013; 13:212. [PMID: 23957955 PMCID: PMC3765468 DOI: 10.1186/1472-6882-13-212] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2013] [Accepted: 08/08/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Fewer than 6% patients with adenocarcinoma of the pancreas live up to five years after diagnosis. Chemotherapy is currently the standard treatment, however, these tumors often develop drug resistance over time. Agents for increasing the cytotoxic effects of chemotherapy or reducing the cancer cells' chemo-resistance to the drugs are required to improve treatment outcome. Nuclear factor kappa B (NF-kB), a pro-inflammatory transcription factor, reportedly plays a significant role in the resistance of pancreatic cancer cells to apoptosis-based chemotherapy. This study investigated the effect of aqueous Moringa Oleifera leaf extract on cultured human pancreatic cancer cells - Panc-1, p34, and COLO 357, and whether it can potentiates the effect of cisplatin chemotherapy on these cells. METHODS The effect of Moringa Oleifera leaf extract alone and in combination with cisplatin on the survival of cultured human pancreatic cancer cells was evaluated by XTT-based colorimetric assay. The distribution of Panc-1 cells in the cell cycle following treatment with Moringa leaf extract was evaluated by flow cytometry, and evaluations of protein levels were via immunoblotting. Data of cell survival following combined treatments were analyzed with Calcusyn software. RESULTS Moringa Oleifera leaf extract inhibited the growth of all pancreatic cell lines tested. This effect was significant in all cells following exposure to ≥0.75 mg/ml of the extract. Exposure of Panc-1 cells to Moringa leaf extract induced an elevation in the sub-G1 cell population of the cell-cycle, and reduced the expression of p65, p-IkBα and IkBα proteins in crude cell extracts. Lastly, Moringa Oleifera leaf extract synergistically enhanced the cytotoxic effect of cisplatin on Panc-1 cells. CONCLUSION Moringa Oleifera leaf extract inhibits the growth of pancreatic cancer cells, the cells NF-κB signaling pathway, and increases the efficacy of chemotherapy in human pancreatic cancer cells.
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Strippoli S, Lorusso V, Albano A, Guida M. Herbal-drug interaction induced rhabdomyolysis in a liposarcoma patient receiving trabectedin. Altern Ther Health Med 2013; 13:199. [PMID: 23899130 PMCID: PMC3737021 DOI: 10.1186/1472-6882-13-199] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 07/16/2013] [Indexed: 01/26/2023]
Abstract
BACKGROUND Rhabdomyolysis is an uncommon side effect of trabectedin which is used for the second line therapy of metastatic sarcoma after anthracycline and ifosfamide failure. This side effect may be due to pharmacokinetic interactions caused by shared mechanisms of metabolism involving the cytochrome P450 (CYP) system in the liver. Here, for the first time in literature, we describe the unexpected onset of heavy toxicity, including rhabdomyolysis, after the fourth course of trabectedin in a patient with retroperitoneal liposarcoma who at the same time was taking an alternative herbal medicine suspected of triggering this adverse event. CASE PRESENTATION This is the case of a 56 year old Caucasian man affected by a relapsed de-differentiated liposarcoma who, after the fourth cycle of second-line chemotherapy with trabectedin, complained of sudden weakness, difficulty walking and diffuse muscle pain necessitating complete bed rest. Upon admission to our ward the patient showed grade (G) 4 pancytopenia and a marked increase in liver lytic enzymes, serum levels of myoglobin, creatine phosphokinase (CPK) and lactate dehydrogenase. No cardiac or kidney function injuries were present. Based on these clinical and laboratory features, our conclusive diagnosis was of rhabdomyolysis induced by trabectedin.The patient did not report any trauma or muscular overexertion and no co-morbidities were present. He had not received any drugs during treatment with trabectedin, but upon further questioning the patient informed us he had been taking a folk medicine preparation of chokeberry (Aronia melanocarpa) daily during the last course of trabectedin and in the 2 subsequent weeks.One week after hospitalization and cessation of intake of chokeberry extract, CPK and other markers of myolysis slowly returned to standard range, and the patient noted a progressive recovery of muscle strength.The patient was discharged on day 14 when a blood transfusion and parenteral hydration gradually lowered general toxicity. Progressive mobilization of the patient was obtained as well as a complete normalization of the laboratory findings. CONCLUSIONS The level of evidence of drug interaction leading to the adverse event observed in our patient was 2 (probable). Thus our case underlines the importance of understanding rare treatment-related toxicities such as trabectedin-induced rhabdomyolysis and the possible role of the drug-drug interactions in the pathogenesis of this rare side effect. Furthermore, this report draws attention to a potential problem of particular concern, that of nutritional supplements and complementary and alternative drug interactions. These are not widely recognized and can cause treatment failure.
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Xia Q, Wang ZY, Li HQ, Diao YT, Li XL, Cui J, Chen XL, Li H. Reversion of p-glycoprotein-mediated multidrug resistance in human leukemic cell line by diallyl trisulfide. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2012; 2012:719805. [PMID: 22919419 PMCID: PMC3418761 DOI: 10.1155/2012/719805] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 05/16/2012] [Indexed: 12/15/2022]
Abstract
Multidrug resistance (MDR) is the major obstacle in chemotherapy, which involves multiple signaling pathways. Diallyl trisulfide (DATS) is the main sulfuric compound in garlic. In the present study, we aimed to explore whether DATS could overcome P-glycoprotein-(P-gp-)mediated MDR in K562/A02 cells, and to investigate whether NF-κB suppression is involved in DATS-induced reversal of MDR. MTT assay revealed that cotreatment with DATS increased the response of K562/A02 cells to adriamycin (the resistance reversal fold was 3.79) without toxic side effects. DATS could enhance the intracellular concentration of adriamycin by inhibiting the function and expression of P-gp, as shown by flow cytometry, RT-PCR, and western blot. In addition, DATS resulted in more K562/A02 cell apoptosis, accompanied by increased expression of caspase-3. The expression of NF-κB/p65 (downregulation) was significantly linked to the drug-resistance mechanism of DATS, whereas the expression of IκBα was not affected by DATS. Our findings demonstrated that DATS can serve as a novel, nontoxic modulator of MDR, and can reverse the MDR of K562/A02 cells in vitro by increasing intracellular adriamycin concentration and inducing apoptosis. More importantly, we proved for the first time that the suppression of NF-κB possibly involves the molecular mechanism in the course of reversion by DATS.
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Affiliation(s)
- Qing Xia
- Department of Hematology, Qilu Hospital, Shandong University, Shandong, Jinan 250012, China
| | - Zhi-Yong Wang
- Department of Emergency, Qilu Hospital, Shandong University, Shandong, Jinan 250012, China
| | - Hui-Qing Li
- Institute of Basic Medicine, Shandong Academy of Medical Sciences, Shandong, Jinan 250062, China
| | - Yu-Tao Diao
- Institute of Basic Medicine, Shandong Academy of Medical Sciences, Shandong, Jinan 250062, China
| | - Xiao-Li Li
- Soochow University and Department of Hematology, Branch Guangci of First Affiliated Hospital, Jiangsu, Suzhou 215128, China
| | - Jia Cui
- Shouguang Centre for Disease Control and Prevention, Shouguang 262700, China
| | - Xue-Liang Chen
- Department of Hematology, Qilu Hospital, Shandong University, Shandong, Jinan 250012, China
| | - Hao Li
- Department of Hematology, Qilu Hospital, Shandong University, Shandong, Jinan 250012, China
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Maggiore RJ, Gross CP, Togawa K, Tew WP, Mohile SG, Owusu C, Klepin HD, Lichtman SM, Gajra A, Ramani R, Katheria V, Klapper SM, Hansen K, Hurria A. Use of complementary medications among older adults with cancer. Cancer 2012; 118:4815-23. [PMID: 22359348 DOI: 10.1002/cncr.27427] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2011] [Revised: 12/04/2011] [Accepted: 12/08/2011] [Indexed: 11/11/2022]
Abstract
BACKGROUND Little is known about complementary medication use among older adults with cancer, particularly those who are receiving chemotherapy. The objective of this study was to evaluate the prevalence of complementary medication use and to identify the factors associated with its use among older adults with cancer. METHODS The prevalence of complementary medication use (defined as herbal agents, minerals, or other dietary supplements, excluding vitamins) was evaluated in a cohort of adults aged ≥65 years who were about to start chemotherapy for their cancer. The associations between complementary medication use and patient characteristics (sociodemographics; comorbidities; and functional, nutritional, psychological, and cognitive status), medication use (number of medications and concurrent vitamin use), and cancer characteristics (type and stage) were analyzed. RESULTS The cohort included 545 patients (mean age, 73 years; range, 65-91 years; 52% women) with cancer (61% stage IV). Seventeen percent of these patients (N = 93) reported using ≥1 complementary medication; the mean number of complementary medications among users was 2 (range, 1-10 medications). Complementary medication use was associated with 1) earlier cancer stage (29% had stage I-II disease vs 17% with stage III-IV disease; odds ratio [OR], 2.05; 95% confidence interval [CI], 1.21-3.49) and 2) less impairment with instrumental activities of daily living (OR, 1.39; 95% CI, 1.12-1.73). CONCLUSIONS Complementary medication use was reported by 17% of older adults with cancer and was more common among those who had less advanced disease (i.e., those receiving adjuvant, potentially curative treatment) and higher functional status. Further studies are needed to determine the association between complementary medication use and cancer outcomes among older adults.
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Affiliation(s)
- Ronald J Maggiore
- Department of Medicine, Sections of Geriatrics/Palliative Medicine and Hematology/Oncology, University of Chicago Medical Center, Chicago, Illinois, USA
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Shenoy C, Klem I, Crowley AL, Patel MR, Winchester MA, Owusu C, Kimmick GG. Cardiovascular complications of breast cancer therapy in older adults. Oncologist 2011; 16:1138-43. [PMID: 21737575 DOI: 10.1634/theoncologist.2010-0348] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Older adults frequently have pre-existing and cancer-related risk factors for cardiovascular toxicity from cancer treatment. In this review, we discuss the risk factors and strategies for prevention and management of cardiovascular complications in older women with breast cancer.
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Affiliation(s)
- Chetan Shenoy
- Division of Cardiology, Duke University Medical Center, Durham, North Carolina 27710, USA.
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Abstract
More and more elderly people with cancer are treated in oncology clinics worldwide every year, many of whom have comorbid disorders treated with one or more drugs. Moreover, these patients might also take self-prescribed over-the-counter drugs or complementary and alternative medicines, which they might not tell their doctor about. Initiation of chemotherapy with one or more cytotoxic or targeted agents and drugs for treatment of cancer symptoms or toxic effects related to treatment can result in polypharmacy. We examine the clinical implications of polypharmacy. Challenges for the medical teams who treat elderly patients with cancer include identification of what drugs are actually being taken by the patient, avoidance or management of any adverse effects or drug interactions, and reassessing the patient's overall treatment. We address these issues and propose practical recommendations for management of treatment for elderly patients with cancer.
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Zhang L, Zhang S. Modulating Bcl-2 family proteins and caspase-3 in induction of apoptosis by paeoniflorin in human cervical cancer cells. Phytother Res 2011; 25:1551-7. [PMID: 21698669 DOI: 10.1002/ptr.3534] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2010] [Revised: 04/06/2011] [Accepted: 04/06/2011] [Indexed: 12/30/2022]
Abstract
Paeoniflorin (PF), the principal bioactive component in the paeony root, has been used alone or combined with other herbs for many years in traditional Chinese medicine. New studies have shown that PF possesses an antitumor effect. However, the effect of PF on human cervical cancer cells has not been reported previously. This study determined the effect of PF on human cervical cancer cell line (HeLa) cells by the methyl thiazolyl tetrazolium (MTT) assay, flow cytometry with annexin V-fluorescein isothiocyanate (FITC)/propidium iodide (PI) technology, the transmission electron microscope (TEM) and immunocytochemical technique. After treatment with PF, the proliferation of HeLa cells was inhibited in a dose and time-dependent manner (p < 0.05). The apoptosis rate of HeLa cells increased with ascending concentrations of PF (p < 0.05) and the proportion of HeLa cells in S phase showed an increasing trend also. Typical apoptotic changes of HeLa cells exposed to PF were seen under the TEM. Meanwhile, there was a decrease in the expression of Bcl-2 and an enhancement in the expression of Bax and caspase-3 genes compared with the control group (p < 0.05). In conclusion, PF can induce significantly the apoptosis of HeLa cells, which may be demonstrated by the down-regulation of anti-apoptosis gene Bcl-2 and the up-regulation of pro-apoptosis genes Bax and caspase-3.
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Affiliation(s)
- Lili Zhang
- Department of Obstetrics and Gynecology, the Affiliated Shengjing Hospital of China Medical University, Shenyang, China
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He SM, Yang AK, Li XT, Du YM, Zhou SF. Effects of herbal products on the metabolism and transport of anticancer agents. Expert Opin Drug Metab Toxicol 2010; 6:1195-213. [PMID: 20701553 DOI: 10.1517/17425255.2010.510132] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
IMPORTANCE OF THE FIELD Cancer patients on chemotherapy treatment often seek herbal therapies and this may alter the clearance of anticancer drugs. AREAS COVERED IN THIS REVIEW Many anticancer drugs are metabolized by CYPs and are substrates of P-glycoprotein, breast cancer resistance protein and multi-drug resistance proteins. CYPs and drug transporters are subject to inhibition and/or induction by the herbal medicines used by cancer patients and the metabolism and pharmacokinetics of anticancer agents may be altered by herbal products. There are increased reports on the interaction of herbal medicines with anticancer agents. A clinical study in cancer patients reported that treatment of St John's wort at 900 mg/day orally for 18 days decreased the plasma levels of the active metabolite of irinotecan, SN-38, by 42%. In healthy subjects, treatment with St John's wort for 2 weeks significantly decreased the systemic exposure of imatinib by 32%. Induction and/or inhibition of CYPs and transporters is considered an important mechanism for these interactions. WHAT THE READER WILL GAIN Potential interactions of herbal medicines with anticancer agents have become a safety concern in cancer chemotherapy. TAKE HOME MESSAGE Further studies are warranted to investigate the efficacy and safety profiles of herbal medicines commonly used by cancer patients.
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Affiliation(s)
- Shu-Ming He
- Xiaolan People's Hospital Affiliated to Nanfang Medical University, Department of Obstetrics and Gynecology, Zhongshan, Guangdong, China
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Ben-Arye E, Attias S, Tadmor T, Schiff E. Herbs in hemato-oncological care: an evidence-based review of data on efficacy, safety, and drug interactions. Leuk Lymphoma 2010; 51:1414-23. [PMID: 20528250 DOI: 10.3109/10428194.2010.487622] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Herbal remedies are clearly a complementary and alternative modality used frequently by patients with hemato-oncological neoplasias during the course of their specific treatment. This review focuses on the potential safety and efficacy of herbs which are either used often or even on a daily basis by patients with hematological malignancies or indicated in the herbal pharmacopeias utilized by various traditional systems of medicine, in order to improve the well-being of patients with these cancers. Traditional medicine worldwide is a source for ongoing laboratory research related to the activity of herbs on cultured cell lines derived from patients with leukemia, lymphoma, and myeloma. Although the number of clinical studies in the field of hemato-oncology is limited, there appears to be potential efficacy in studies of mistletoe (Viscum album), green tea, Indian and Middle-Eastern spices, and some traditional Chinese, American, and European herbs. In addition to the potential efficacy of herbs, safety issues are also reviewed here, particularly, the documented and potential side effects, herb-drug interactions, and matters of quality control. Based on the above issues, the authors suggest enhancing doctor-patient communication regarding herbal use by adopting a patient-centered attitude based on scientific perspective.
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Affiliation(s)
- Eran Ben-Arye
- Integrative Oncology Program, The Oncology Service and Lin Medical Center, Clalit Health Services, Haifa and Western Galilee District, Israel.
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Evidence-Based Management of Herb-Drug Interaction in Cancer Chemotherapy. Explore (NY) 2010; 6:324-9. [DOI: 10.1016/j.explore.2010.06.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2009] [Indexed: 12/11/2022]
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Avcı CB, Gündüz C, Baran Y, Sahin F, Yılmaz S, Dogan ZO, Saydam G. Caffeic acid phenethyl ester triggers apoptosis through induction of loss of mitochondrial membrane potential in CCRF-CEM cells. J Cancer Res Clin Oncol 2010; 137:41-7. [PMID: 20221636 DOI: 10.1007/s00432-010-0857-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2010] [Accepted: 02/19/2010] [Indexed: 12/29/2022]
Abstract
PURPOSE CAPE (caffeic acid phenethyl ester) is one of the most valuable and investigated component of propolis which is composed by honeybees. In the current study, we aimed at examining apoptotic effects of CAPE on CCRF-CEM leukemic cells and at determining the roles of mitochondrial membrane potential (MMP) in cell death. METHODS Trypan blue and XTT methods were used to evaluate the cytotoxicity. Apoptosis was examined by ELISA-based oligonucleotide and acridine orange/ethidium bromide dye techniques. Loss of mitochondrial membrane potential was evaluated using JC-1 dye by flow cytometric analysis and under fluorescent microscope. RESULTS We detected the time- and dose-dependent increases in cytotoxic effect of CAPE on CCRF-CEM cells. ELISA and acridine orange/ethidium bromide results showed that apoptotic cell population increased significantly in CCRF-CEM cells exposed to increasing concentrations of CAPE. On the other hand, there was significant loss of MMP determined in response to CAPE in CCRF-CEM cells. CONCLUSION This in vitro data by being supported with clinical data may open the way of the potential use of CAPE for the treatment of leukemia.
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Affiliation(s)
- Cığır Biray Avcı
- Department of Medical Biology, School of Medicine, Ege University, Bornova, Izmir 35100, Turkey
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