Herb–drug interactions between the medicinal mushrooms Lingzhi and Yunzhi and cytotoxic anticancer drugs: a systematic review

Abstract

Background: Lingzhi and Yunzhi are medicinal mushrooms commonly used with cytotoxic chemotherapy in cancer patients in Asian countries. The current systematic review aims to identify potential pharmacokinetic or pharmacodynamic interactions from the existing literature to ensure their effective and safe combination usage in cancer patients. Methods: A systematic search was conducted on nine major Chinese and English databases, including China Journal Net, Allied and Complementary Medicine Database, and Ovid MEDLINE ® , etc., to identify clinical, animal, and in-vitro studies that evaluate the effect of combined use of Lingzhi or Yunzhi with cytotoxic drugs. The Jadad scale was used to assess the quality of clinical studies. Results: This search identified 213 studies, including 77 clinical studies that reported on the combined use of cytotoxic drugs with Yunzhi (n = 56) or Lingzhi (n = 21). Majority of these clinical studies demonstrated modest methodological quality. In clinical practice, the most commonly used cytotoxic drugs with Lingzhi were cisplatin, 5-fluorouracil (5-FU) and paclitaxel, whereas Tegafur/uracil (UFT)/Tegafur, 5-FU, and mitomycin were the ones used more often with Yunzhi. Only two clinical pharmacokinetic studies were available showing no significant interactions between Polysaccharide K (PSK) and Tegafur. From the pharmacodynamic interactions perspective, combination uses of Yunzhi/Lingzhi with cytotoxic drugs in clinical practice could lead to improvement in survival (n = 31) and quality of life (n = 17), reduction in tumor lesions (n = 22), immune modulation (n = 38), and alleviation of chemotherapy-related side effects (n = 14) with no reported adverse effects. Conclusion: Our findings suggest that the clinical combination use of Lingzhi or Yunzhi with cytotoxic drugs could enhance the efficacy and ameliorate the adverse effects of cytotoxic drugs, leading to improved quality of life in cancer patients. More high quality clinical studies including pharmacokinetic herb-drug interactions studies are warranted to verify these observations and mechanisms involved. Based on the high quality clinical data, pharmacoepidemiology methods and bioinformatics or data mining could be adopt for further identification of clinical meaningful herb-drug interactions in cancer therapies.

Evaluation of Concomitant Use of Anticancer Drugs and Herbal Products: From Interactions to Synergic Activity

“…In particular, two medicinal mushrooms belonging to Polyporaceae , namely lingzhi (reishi) and yunzhi, are used as adjuvants in cancer therapy not only in the East but also in Canada, the United States, and Europe. At the clinical level, yunzhi is coadministered with ACDs such as 5 FU, tegafur/uracil, and mitomycin, while linghzi is coadministered with cisplatin, paclitaxel, and 5 FU in most of the clinical trials that were analyzed [ 35 ]. From the analysis of 77 clinical trials, combining these two fungi with ACDs could improve the survival rates and HR -QoL of patients under cancer treatment [ 35 ].…”

“…Table 3 [ 7 , 8 , 9 , 16 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 ] lists the best-known, studied, and used CAMs whose main recognized role is to improve HR-QoL, although there is conflicting evidence that CAM improves HR-QoL and symptoms [ 21 , 22 ].…”

Mushroom Nutrition as Preventative Healthcare in Sub-Saharan Africa

“…Usually, the causes of cancer are multifactorial, and they include genetic, environmental, and other risk factors. A recent meta-analysis of 213 studies, including 77 clinical studies, showed that Ganoderma lucidum or Coriolus versicolor mushrooms enhanced the efficacy and ameliorated their adverse effects, which lead to an improved quality of life in cancer patients [108,167].…”

The Strategy of Studying the Herb-Pair Inter-Reinforcement Mechanism Mapping on Chemical Space Between Sparganii Rhizoma and Curcumae Rhizoma

“…The herb-pair has their inherent prescriptions and it is a bridge between single herb and prescriptions. Traditional Chinese medicine (TCM)-herbal mixtures developed though observation and experience accumulated over thousands of years, but with unknown mechanisms of action [9].…”