Real-world data on herb-drug interactions in oncology: A scoping review of pharmacoepidemiological studies

Factors influencing the utilization of Traditional Chinese Medicine in cancer treatment: a qualitative meta-synthesis of patient and healthcare professional perspectives

Background

The complementary role of Traditional Chinese Medicine (TCM) in cancer management has been widely acknowledged. However, its implementation continues to face numerous challenges. Identifying and elucidating the factors that influence the integration of TCM into cancer therapy is essential. Developing effective implementation strategies is crucial to transitioning from theoretical evidence to practical application.

Methods

A total of nine databases were systematically searched from their inception until 1 October 2023. The review includes qualitative and mixed-method studies examining the attitudes and perceptions of patients and healthcare providers toward the use of TCM in cancer treatment. The studies included were evaluated using a quality assessment tool. An appropriate model or framework was to identify potential facilitators and impediments affecting TCM implementation. Based on the identified barriers, potential behavior change interventions were subsequently developed.

Results

A total of 39 studies are included in the review, comprising 31 qualitative and eight mixed-methods studies. The quality of these studies is acceptable. Key barriers to the implementation of TCM were identified as follows: insufficient knowledge and experience in TCM, neglect of details in doctor-patient communication, limited number of specialists, lack of funding, and absence of a multidisciplinary collaborative atmosphere. In response to these barriers, we recommend improving structured referral pathways, developing a structured communication manual, and other targeted interventions to enhance the integration of TCM in cancer care.

Conclusion

This study identifies 48 factors that influence the implementation of TCM and tentatively proposes a series of intervention strategies. Future research should focus on localized empirical studies of factors and strategies in different healthcare settings.

Systematic review registration

https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=421822, identifier CRD42023421822.

Mechanism of Action and Interaction of Garlic Extract and Established Therapeutics in Prostate Cancer

A detailed characterization of the mechanism of action of garlic extract (GE) on prostate cancer (PCa) cells is essential to ensure its safe use as a complementary therapy, particularly when combined with established treatments. A case report highlighted the potential benefits of GE in PCa management. A patient diagnosed with PCa, presenting an initial prostate-specific antigen (PSA) of 11.8 ng/mL, maintained PSA levels between 3.5 and 6 ng/mL for over 14 years with daily GE intake. To study GE's anti-proliferative effects and interactions with established therapeutics, healthy prostate epithelial cells (PNT2) and PCa cells (LNCaP, PC3, VCaP) were treated with GE. Proliferation, Integrin β1 pattern, DNA-damage, as well as androgen receptor (AR) and Cytochrome P450 (CYP450) expression were investigated. GE reduced the proliferation of LNCaP and PC3 cells compared to healthy PNT2 cells but had contrary effects on VCaP cells. The combination of GE with standard therapies, including chemotherapy, androgen deprivation therapy (ADT), and Poly-(ADP-ribose)-Polymerase inhibitors (PARPi), reduced the efficacy of these treatments in tumor cells, potentially due to the GE-induced upregulation of the metabolic enzyme CYP2C9 in PCa cell lines. These findings indicate that while GE has anti-proliferative effects, the use of highly concentrated natural extracts must be carefully assessed by expert physicians on a case-by-case basis, especially when combined with established therapies.

Fostering the Conversation About Complementary Medicine: Acceptability and Usefulness of Two Communication-Supporting Tools for Patients with Cancer

Both patients and providers experience barriers to discussing complementary medicine during oncology consultations. This study describes the development of two communication tools-a question prompt sheet and a visual slideshow-and aims to evaluate their acceptability, perceived usefulness, and intention to use among patients with cancer. Nine (former) patients with breast cancer were involved in the development of the tools as co-researchers. The 15-item evaluation questionnaire was completed by 144 participants recruited from three Dutch hospitals, a patient panel, and the Dutch Breast Cancer Society. The tools' content and layout were generally acceptable, although suggestions were made to include items on exercise and diet in the question prompt sheet. About half of the participants found the tools useful, while the other half felt they were unnecessary, either because they could already discuss complementary medicine with their healthcare provider or had no interest in the topic. The tools were considered particularly helpful for fellow patients. The tools were well received though minor modifications were suggested. The lack of perceived need by half of the participants may have influenced the results. For effective use of the tools, it is important to identify patients who need extra support in discussing complementary medicine.

Effectiveness of Semecarpus anacardium Linn. fruits in cancer and inflammatory diseases: A mini review

BACKGROUND

Semecarpus anacardium Linn. (SCA) fruits are found in India's sub-Himalayan, tropical, and central regions and have been utilized for centuries in traditional Indian medicine to treat various ailments. In recent times, a growing body of research has emerged indicating that the extracts and active components found in SCA fruits possess qualities that can potentially inhibit the development of cancer and inflammatory markers.

PURPOSE

This study aims to provide a comprehensive review of the existing literature on the pharmacological mechanisms underlying the effects of extracts and phytochemicals of SCA fruits in cellular, animal models, and clinical trials of cancer and inflammatory diseases.

METHODS

A comprehensive literature search was conducted utilizing several databases, including PubMed, Scopus, Google Scholar, preprint platforms, and the Cochrane Database of Systematic Reviews using the keywords "Semecarpus anacardium", "Anti-inflammatory," and "cancer". The collection of articles started with establishing the database and continued until April 2024.

RESULTS

Out of 1130 retrieved database records, 316 pertained to systematic reviews. The remaining 814 records focused on examining the anticancer and anti-inflammatory properties of SCA fruits. In the course of these investigations, the four primary cancer types linked to SCA fruits are identified as lung cancer, hepatocellular carcinoma, breast cancer, and blood cancer.

CONCLUSION

The findings will provide more support for investigating SCA fruits in cancer treatment and will furnish thorough reference data and recommendations for future studies on this botanical medication.

The use of potentially interacting supplement-drug pairs in adults with type 2 diabetes: A large population-based cohort study in the UK Biobank

AIMS

To examine the patterns of use of potentially interacting supplement-drug pairs in adults with type 2 diabetes (T2D) in real-world settings, and to explore the impact of potentially interacting supplement-drug pairs on downstream outcomes.

METHODS

Potentially interacting supplement-drug pairs were identified from four tertiary databases. We categorized the potential pharmacodynamic interactions into different clinical types according to their related outcomes and explored their associations with incident outcomes using Cox models.

RESULTS

26,394 participants with T2D in the UK Biobank were included. Half (48.5 %) were supplement users, of whom 85.0 % were taking potentially interacting supplement-drug pairs. The potential pharmacodynamic interactions were related to various clinical outcomes, including reducing the effects of glucose-lowering drugs (50.7 %), hypotension (49.8 %), bleeding (50.4 %) and hepatotoxicity (34.8 %). Exploratory analyses found that the use of potentially interacting supplement-drug pairs was associated with incident hepatic diseases (hazard ratio = 1.26, 95 % confidence interval 1.10-1.44, P < 0.001).

CONCLUSIONS

Real-world data suggests that most adults with T2D who concurrently used supplements and drugs were on potentially interacting supplement-drug combinations, with the potential of causing adverse outcomes such as incident hepatic diseases. Clinicians should communicate with patients and assess the potential risk of supplement-drug interactions in clinical settings.

Establishing an Integrative Oncology Service: Essential Aspects of Program Development

PURPOSE OF REVIEW

Over the last 2 decades, integrative oncology (IO) has seen exponential growth within cancer care. It aims to combine evidence-based complementary therapies with conventional treatments to improve the well-being and quality of life for individuals dealing with cancer. The proliferation of integrative medicine programs in major cancer centers globally reflects varying approaches shaped by cultural, demographic, and resource-based factors.

RECENT FINDINGS

Drawing upon the expertise of leaders in IO from the Society for Integrative Oncology (SIO) Clinical Practice Committee, this manuscript serves as a practical guide for establishing an IO practice. Collating insights from diverse professionals, including oncologists, integrative oncologists, supportive care physicians, researchers, and clinicians, the paper aims to provide a comprehensive roadmap for initiating and advancing IO services. The primary objective is to bridge the gap between conventional cancer care and complementary therapies, fostering a patient-centric approach to address the multifaceted challenges encountered by individuals with cancer. This paper delineates several key sections elucidating different aspects of IO practice. It delves into the core components necessary for an IO service's foundation, outlines the initial medical consultation process, and presents crucial tools essential for successful consultations. By consolidating insights and expertise, this manuscript seeks to facilitate the integration of IO into mainstream cancer care, ultimately enhancing patient outcomes and experiences.

New insight into the mechanisms of Ginkgo biloba leaves in the treatment of cancer

BACKGROUND

Ginkgo biloba leaves (GBLs), as an herbal dietary supplement and a traditional Chinese medicine, have been used in treating diseases for hundred years. Recently, increasing evidence reveals that the extracts and active ingredients of GBLs have anti-cancer (chemo-preventive) properties. However, the molecular mechanism of GBLs in anti-cancer has not been comprehensively summarized.

PURPOSE

To systematically summarize the literatures for identifying the molecular mechanism of GBLs in cellular, animal models and clinical trials of cancers, as well as for critically evaluating the current evidence of efficacy and safety of GBLs for cancers.

METHODS

Employing the search terms "Ginkgo biloba" and "cancer" till July 25, 2023, a comprehensive search was carried out in four electronic databases including Scopus, PubMed, Google Scholar and Web of Science. The articles not contained in the databases are performed by manual searches and all the literatures on anti-cancer research and mechanism of action of GBLs was extracted and summarized. The quality of methodology was assessed independently through PRISMA 2020.

RESULTS

Among 84 records found in the database, 28 were systematic reviews related to GBLs, while the remaining 56 records were related to the anticancer effects of GBLs, which include studies on the anticancer activities and mechanisms of extracts or its components in GBLs at cellular, animal, and clinical levels. During these studies, the top six cancer types associated with GBLs are lung cancer, hepatocellular carcinoma, gastric cancer, breast cancer, colorectal cancer, and cervical cancer. Further analysis reveals that GBLs primarily exert their anticancer effects by stimulating cancer cell apoptosis, inhibiting cell proliferation, invasion and migration of cancers, exhibiting anti-inflammatory and antioxidant properties, and modulating signaling pathways. Besides, the pharmacology, toxicology, and clinical research on the anti-tumor activity of GBLs have also been discussed.

CONCLUSIONS

This is the first paper to thoroughly investigate the pharmacology effect, toxicology, and the mechanisms of action of GBLs for anti-cancer properties. All the findings will reinforce the need to explore the new usage of GBLs in cancers and offer comprehensive reference data and recommendations for future research on this herbal medicine.

Association between potential supplement-drug interactions and liver diseases in patients with cancer: A large prospective cohort study

BACKGROUND & AIMS

The concurrent use of herbal and dietary supplements and conventional drugs can lead to interactions in patients with cancer, of which hepatotoxicity is one of the most concerning sequelae. This study examined the potential supplement-drug interactions involving the hepatic system, and their associations with documented liver diseases, among patients with cancer in a large population-based cohort in the UK Biobank.

METHODS

Participants diagnosed with cancer and had completed supplement-use assessment after diagnosis were included. Potentially interacting supplement-drug combinations that involved CYP enzymes or increased the risk of hepatotoxicity were identified from four tertiary databases. Liver diseases were identified using ICD-codes K70-77. Log-binomial regression was used to investigate the associations between potentially-interacting supplement-drug combinations and liver diseases documented (1) at any time, and (2) confined to only after the time of supplement-use assessment, adjusting for age, sex and pre-existing comorbidities.

RESULTS

This analysis included 30,239 participants (mean age = 60.0 years; 61.9% female). Over half (n = 17,698, 58.5%) reported the use of supplements after cancer diagnoses. Among supplements users, 36.9% (n = 6537/17,698) were on supplement-drug combinations with interacting potential involving the hepatic system. Patients taking supplements and drugs who had hepatic comorbidities were more likely to take potentially interacting pairs (adjusted risk ratio = 1.14, 95% CI = 1.06-1.23, p < 0.001). However, no significant association was observed between the use of these combinations and subsequent liver diseases (all p > 0.05).

CONCLUSION

Approximately one-third of the participants who had cancer and were supplement users had a risk of potential supplement-drug interactions that contribute to adverse liver effect. Healthcare professionals should communicate with patients with cancer, especially those with pre-existing liver diseases, about supplement use and proactively assess the clinical significance of potential interactions.

Integrative oncology in cancer care - implementation factors: mixed-methods systematic review

BACKGROUND

Integrative oncology (IO) appears to be beneficial to patients with cancer, but its implementation remains a challenge. Guided by the Theoretical Domains Framework (TDF) and the Capability-Opportunity-Motivation-Behaviour (COM-B) model, this systematic review identified the barriers to and facilitators of IO implementation in conventional cancer care settings.

METHODS

We searched eight electronic databases from their inception until February 2022 for qualitative, quantitative or mixed-methods empirical studies reporting the implementation outcomes for IO services. Critical appraisal approach was tailored according to study types. The identified implementation barriers and facilitators were mapped onto TDF domains and the COM-B model, and subsequently onto the behavioural change wheel (BCW) for formulating behavioural change interventions.

RESULTS

We included 28 studies (11 qualitative, 6 quantitative, 9 mixed-methods and 2 Delphi studies) of satisfied methodological quality. The main implementation barriers were the lack of IO knowledge, the absence of funding and healthcare professionals' low level of IO receptiveness. The key implementation facilitators were the dissemination of evidence on IO clinical benefits, the equipping of professionals with IO service delivery skills and the provision of a supportive organisational climate.

CONCLUSION

Multifaceted implementation strategies are needed to address the determinants influencing IO service delivery. Based on our BCW-based analysis of the included studies, the key behavioural change techniques are: (1) educating healthcare professionals about the value and application of traditional and complementary medicine; (2) ensuring access to actionable clinical evidence on IO effectiveness and safety and (3) designing guidelines on communicating traditional and complementary medicine interventions with patients and caregivers for biomedically trained doctors and nurses.

Everyday Evaluation of Herb/Dietary Supplement–Drug Interaction: A Pilot Study

A lack of reliable information hinders the clinician evaluation of suspected herb–drug interactions. This pilot study was a survey-based study conceived as a descriptive analysis of real-life experiences with herb–drug interaction from the perspective of herbalists, licensed health-care providers, and lay persons. Reported dietary supplement–drug interactions were evaluated against the resources most commonly cited for the evaluation of potential supplement–drug interactions. Disproportionality analyses were performed using tools available to most clinicians using data from the U.S. Federal Adverse Event Reporting System (FAERS) and the US Center for Food Safety and Applied Nutrition (CFSAN) Adverse Event Reporting System (CAERS). Secondary aims of the study included exploration of the reasons for respondent use of dietary supplements and qualitative analysis of respondent’s perceptions of dietary supplement–drug interaction. While agreement among reported supplement–drug interactions with commonly cited resources for supplement–drug interaction evaluation and via disproportionality analyses through FAERS was low, agreement using data from CAERS was high.

Current Characteristics of Herbal Medicine Interventions for Cancer on Clinical Databases: A Cross-Sectional Study

BACKGROUND

The utilization of herbal medicine has been noteworthy for treating cancer; however, there is not enough information regarding the characteristics of clinical trials of herbal medicine interventions. This study aimed to evaluate the characteristic of registered trials using herbal medicine interventions for cancer.

METHODS

A cross-sectional study was performed via the website ClinicalTrials.gov, ISRCTN registry, Chinese clinical trial registry, and international clinical trials registry platform to gather associated registered clinical trials using an advanced search with the developed keyword strategy as of March 26, 2023. All obtainable information from the trials was collected without any restrictions to conduct a comprehensive review.

RESULTS

A total of 169 registered trials were included for evaluation. Of all trials, 102 trials were eligible for this study. Countries from Asia registered the most trials (62.75%), and hospitals sponsored most of the trials (42.16%). Randomized, Phase 2, interventional trials were dominant, and approximately 64.71% of the trials anticipated recruiting less than 100 participants. More than half of the trials were from 2016 to 2023 (53.92%). While 45 trials were completed, only 16 trials had results for further analysis. According to the completed results, the types of herbal medicines from the trials mainly focused on lung, breast, and colorectal cancer.

CONCLUSION

This study is the first to explore the characteristics of clinical trials of herbal medicine for cancer registered in large clinical databases. The acquired trials had relatively informative data; however, better-designed trials may be needed for health professionals to consider herbal medicine as an option when treating cancer patients.

Schisantherin A inhibits cell proliferation by regulating glucose metabolism pathway in hepatocellular carcinoma

Schisantherin A (STA) is a traditional Chinese medicine extracted from the plant Schisandra chinensis, which has a wide range of anti-inflammatory, antioxidant, and other pharmacological effects. This study investigates the anti-hepatocellular carcinoma effects of STA and the underlying mechanisms. STA significantly inhibits the proliferation and migration of Hep3B and HCCLM3 cells in vitro in a concentration-dependent manner. RNA-sequencing showed that 77 genes are upregulated and 136 genes are downregulated in STA-treated cells compared with untreated cells. KEGG pathway analysis showed significant enrichment in galactose metabolism as well as in fructose and mannose metabolism. Further gas chromatography-mass spectrometric analysis (GC-MS) confirmed this, indicating that STA significantly inhibits the glucose metabolism pathway of Hep3B cells. Tumor xenograft in nude mice showed that STA has a significant inhibitory effect on tumor growth in vivo. In conclusion, our results indicate that STA can inhibit cell proliferation by regulating glucose metabolism, with subsequent anti-tumor effects, and has the potential to be a candidate drug for the treatment of liver cancer.