Prognostic Proof and Possible Therapeutic Mechanisms of Herbal Medicine in Patients With Metastatic Lung and Colon Cancer

M, K M, Dey T, Zargar MI, Singh J. Recent advance of herbal medicines in cancer- a molecular approach

Bioactive compounds are crucial for an extensive range of therapeutic uses, and some exhibit anticancer activity. Scientists advocate that phytochemicals modulate autophagy and apoptosis, involved in the underlying pathobiology of cancer development and regulation. The pharmacological aiming of the autophagy-apoptosis signaling pathway using phytocompounds hence offers an auspicious method that is complementary to conventional cancer chemotherapy. The current review aims to explore the molecular level of the autophagic-apoptotic pathway to know its implication in the pathobiology of cancer and explore the essential cellular process as a druggable anticancer target and therapeutic emergence of naturally derived phytocompound-based anticancer agents. The data in the review were collected from scientific databases such as Google search, Web of Science, PubMed, Scopus, Medline, and Clinical Trials. With a broad outlook, we investigated their cutting-edge scientifically revealed and/or searched pharmacologic effects, a novel mechanism of action, and molecular signaling pathway of phytochemicals in cancer therapy. In this review, the evidence is focused on molecular pharmacology, specifically caspase, Nrf2, NF-kB, autophagic-apoptotic pathway, and several mechanisms to understand their role in cancer biology.

Changes of Kinesin Family Member 18 Pathway in Epithelial Mesenchymal Transformation and Effect of Butyrate on Migration and Invasion of Colon Cancer Cells

Colon cancer is a common digestive system disease with an increasing incidence. Severe migration and invasion aggravates the deterioration of colon cancer patients. Previous studies have found that epithelial mesenchymal transition (EMT) is closely associated with early transference of colon carcinoma and abnormal changes occur in KIF18 signaling pathway. Butyrate protects colonic mucosa with a considerable effect on the colon. This study predicts that butyrate may reverse EMT process of colon cancer cells through KIF18 signaling pathway, thereby inhibiting cell migration and invasion. In this experiment, EMT model of colon cancer was used to investigate migration and invasion. Human colon cancer cell line SW1116 was cultured and assigned into control group (0 mmol/L butyrate), low concentration group (2 mmol/L), medium concentration group (4 mmol/L), and high concentration group (10 mmol/L). After 72 hours, cell migration and invasion was analyzed by Transwell assays. E-cadherin, Vimentin, and KIF18 level was detected by Western blot and quantitative real-time PCR. After treatment, cell migration and invasion was significantly inhibited compared to control dose-dependently. In addition, Vimentin and KIF18 mRNA level was significantly lower and E-cadherin mRNA was higher in treatment groups than control group in a dose-dependent manner (P < 0.05). Consistently, the profile of protein level of these molecules was similar to mRNA expression profile. Electron microscope showed that after treatment with butyrate, the surface protuberances of colon cancer cells were abnormally increased, especially the vesicular protuberances, which were the microvilli of intestinal mucosal epithelium. In conclusion, KIF18 is crucial in EMT of colon cancer cells. Butyrate may elevate E-cadherin and suppress Vimentin and KIF18 by activating KIF18 signaling, thus inhibiting invasion and migration.

Total ginsenosides of Chinese ginseng induces cell cycle arrest and apoptosis in colorectal carcinoma HT-29 cells

Colorectal carcinoma (CRC) is the most frequent malignant disease of the gastrointestinal tract and it has a poor prognosis. The current treatment options for CRC are far from optimal; they have limited efficacy and toxic effects. Chinese ginseng (the dried root of Panax ginseng) is a medicinal herb, of which ginsenosides are the most effective anticancer component. The aim of the present study was to evaluate the anti-CRC effect of total ginsenosides of Chinese ginseng (TGCG), by analyzing the cellular and molecular pathways. This was done via MTT assay, morphological observation (DAPI staining), flow cytometry for cell cycle and apoptosis analyses, reverse transcription-quantitative polymerase chain reaction and western blot analysis. The results revealed that TGCG inhibited cell proliferation and induced cell cycle arrest and cell apoptosis in HT-29 cells in a dose-dependent manner. The mRNA expression of CDK2, CDK4, CDK6, BAX, CDKN2B, CASP8, CASP3, TP53, TOP1, MYC, MDM2, and CCND1 and the protein expression of cyclin-dependent kinase (Cdk) 2, Cdk4, Cyclin D1, Bax, p21^WAF1, p27^Kip1, c-Myc, p15^INK4b, and p53 were revealed to be modulated by TGCG in HT-29 cells, and are all factors associated with DNA damage, cell proliferation, cell cycle and apoptosis. In conclusion, TGCG induced cell cycle arrest at the G₀/G₁ and G₂/M phases and induced apoptosis in HT-29 cells through the c-Myc- and p53-mediated signaling pathways, possibly in response to DNA damage. Therefore, TGCG may be regarded a promising candidate for development as an anticancer agent for the treatment of CRC.

In Metastatic Non-small cell Lung Cancer Platinum-Based Treated Patients, Herbal Treatment Improves the Quality of Life. A Prospective Randomized Controlled Clinical Trial

Background: According to clinical experience, Traditional Chinese Medicine (TCM) herbs added to platinum-based therapy (PBT) improve the Quality of Life (QOL) in metastatic non-small cell lung cancer (NSCLC) patients, but this must be prospectively validated.

Patients and Methods: Based on clinical impressions regarding the effect of adding TCM herbs to platinum-based chemotherapy, we anticipated that 2 × 21 patients would be sufficient to obtain significant results with an α < 0.05 and power (1 - β) of 90%. To be on the safe side, we enrolled at least 28 patients in each group. In a prospective randomized controlled trial, 61 uniquely defined consecutive patients (PBT+PLACEBO, N = 32; PBT+TCM, N = 29) with stage IIIB-IV, Eastern Cooperative Oncology Group (ECOG) performance scores (PS) = 0–1 and TCM syndrome combined Qi-Yin deficiency were enrolled. These 61 patients were selected from originally 154 consecutive stage IIIB-IV lung cancer patients in the enrollment period. Patients were hospitalized and strictly controlled/surveyed during the entire 2-month treatment period, to guarantee use of or abstinence from TCM herbal and placebo fluids. Occurrence of nausea-vomiting, QOL by Functional Assessment of Cancer Therapy-Lung (FACT-L) scales and changes in ECOG “improved and stable rates” were compared before and after two treatment cycles.

Results: Before treatment, the clinico-pathologic and QOL features in PBT+PLACEBO and PBT+TCM patients did not differ (P > 0.10). The only side effects attributed by some of the patients to the TCM herbs were transient, mild gastric/abdominal heaviness in the first 2 weeks, but these also occurred amongst the PBT+PLACEBO patients (17 and 13%, P > 0.10). The incidence rates of nausea during treatment were 17% in PBT+TCM versus 75% in PBT+PLACEBO; vomiting rates were 14 and 56% (P < 0.0001 and 0.002). Moreover, ECOG “improved and stable rates” were 90% in the PBT+TCM versus 69% in the PBT+PLACEBO group (P = 0.04). In PBT+TCM patients, FACT-L social/familial and functional subscales were better after 2 months’ treatment (P = 0.02 and 0.03). Contrarily, in PBT+PLACEBO patients, the QOL variables total score, physical and emotional subscales were worse after PBT treatment (P = 0.03, 0.0001, and 0.003).

Conclusion: In stage IIIB-IV ECOG-PS = 0–1 NSCLC patients with Qi-Yin deficiency and platinum-based chemotherapy, adding TCM herbal medication improves the QOL. As this category of patients constitutes 40% of all metastatic NSCLCs, these results could have significant clinical impact.

Prescription patterns of Chinese herbal products for post-surgery colon cancer patients in Taiwan

ETHNO-PHARMACOLOGICAL RELEVANCE

Traditional Chinese medicine (TCM) is commonly provided to cancer patients, however, the patterns of prescriptions for this type of medicine in Taiwan are unclear. This study aimed to evaluate the use of traditional Chinese medicine products in colon cancer patients post-surgery in Taiwan and to research patterns of TCM.

MATERIAL AND METHODS

This was a cross-sectional study of newly diagnosed colon cancer patients who received surgery between 2004 and 2008 identified from the National Health Insurance Research Database of Taiwan. The prescription patterns and reasons for the use of TCM for colon cancer were analyzed.

RESULTS

The results showed that "symptoms, signs and ill-defined conditions" (23.3%) and diseases of the digestive system (16.9%) were the most common reasons for using Chinese herbal medicine. Xiang-sha-liu-jun-zi-tang (7.1%), Bu-zhong-yi-qi-tang (4.3%), Jia-wei-xiao-yao-san (4.1%), Shen-Ling-Bai-Zhu-San (3.7%), Ban-Xia-Xie-Xin-Tang (3.4%), Gui-pi-tang (2.4%), Ping-Wei-San (2.4%), Gan-Lu-Yin (2.0%), Bao-He-Wan (1.9%), and Zhen-Ren-Huo-Ming-Yin (1.8%) were the most commonly prescribed single Chinese herbal formulae (CHF) for colon cancer patients post-surgery. Hedyotis diffusa Willd (Bai Hua She She Cao) (5.1%) and Scutellaria barbata (Ban Zhi Lian )(4.8%) were the most commonly prescribed single Chinese herbs.

CONCLUSIONS

This study identified patterns of TCM use in colon cancer patients post-surgery in Taiwan. The herbal ingredients were most commonly used for stimulate ghrelin secretion to increase food intake and had potential anti-tumor effect. However, further research is required to evaluate any beneficial effects which could identify leads for the development of new treatment strategies using TCM.

Therapeutic applications of herbal medicines for cancer patients

Medicinal herbs and their derivative phytocompounds are being increasingly recognized as useful complementary treatments for cancer. A large volume of clinical studies have reported the beneficial effects of herbal medicines on the survival, immune modulation, and quality of life (QOL) of cancer patients, when these herbal medicines are used in combination with conventional therapeutics. Here, we briefly review some examples of clinical studies that investigated the use of herbal medicines for various cancers and the development of randomized controlled trials (RCTs) in this emerging research area. In addition, we also report recent studies on the biochemical and cellular mechanisms of herbal medicines in specific tumor microenvironments and the potential application of specific phytochemicals in cell-based cancer vaccine systems. This review should provide useful technological support for evidence-based application of herbal medicines in cancer therapy.