Potential of chemotherapy?herb interactions in adult cancer patients

McCune, Jeannine S.; Hatfield, Amy J.; Blackburn, Anne A. R.; Leith, Patricia O.; Livingston, Robert B.; Ellis, Georgiana K.

doi:10.1007/s00520-004-0598-1

Cited by 119 publications

(128 citation statements)

References 32 publications

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“…Other reports show that melatonin, coenzyme Q10, green tea extract, cell forte (inositol and inositol hexaphosphate), glucosamine, peppermint, EPA (fish oil), and ginger are also popular dietary supplements/ natural products ( Fig. 1) [15,16].…”

Section: Worldwide Use Of Cammentioning

confidence: 99%

Complementary and Alternative Medicine During Cancer Treatment: Beyond Innocence

et al. 2006

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Nowadays, complementary and alternative medicine (CAM) is popular all over the world. Billions of dollars are spent in this booming business. For several reasons, young, female, educated, and higher socioeconomic class cancer patients, in particular, have shown interest in these agents. Unfortunately, besides direct (and sometimes serious) side effects, several CAM ingredients are capable of interfering with the metabolism of concurrently used drugs, which may render the therapeutic outcome of the subscribed drug unpredictable. In the case of anticancer drugs, with their usually narrow therapeutic window, this may have dramatic consequences and can lead to unacceptable toxicities in some cases or decreased therapeutic activity in others. Therefore, cancer patients should be warned for these possible interactions and be advised to discuss CAM use openly with their treating physician. The general concept that natural products are harmless should thus be changed into a more realistic and responsible attitude. A tightened legislation and regulation (including Internet advertising and sales) could play a crucial role in this awareness process. This should finally enable safe exploration of the potential advantageous aspects of CAM, while living with cancer. The Oncologist 2006;11:732-741

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Section: Worldwide Use Of Cammentioning

confidence: 99%

Complementary and Alternative Medicine During Cancer Treatment: Beyond Innocence

et al. 2006

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“…Although, as a result of a lack of investigations, reports about clinically relevant pharmacokinetic (PK) interactions of CAM with chemotherapeutic drugs are scarce, it is expected that CAM-anticancer drug interactions contribute significantly to the interindividual variations in PK and clinical problems of unexpected toxicities and undertreatment seen in cancer patients. McCune et al [2] estimated that, of the population of patients taking chemotherapeutic drugs and CAM, at least 27% were at risk for developing clinically relevant CAM-drug interactions. It is therefore of utmost importance that treating oncologists are aware of the possibility and consequences of CAM-drug interactions.…”

Section: Introductionmentioning

confidence: 99%

Herb–Drug Interactions in Oncology: Focus on Mechanisms of Induction

2006

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An increasing number of cancer patients are using complementary and alternative medicines (CAM) in combination with their conventional chemotherapeutic treatment. Considering the narrow therapeutic window of oncolytic drugs, this CAM use increases the risk of clinically relevant herb-anticancer drug interactions. Such a relevant interaction is that of St. John's wort with the anticancer drugs irinotecan and imatinib. It is, however, estimated that CAM-anticancer drug interactions are responsible for substantially more unexpected toxicities of chemotherapeutic drugs and possible undertreatment seen in cancer patients.Induction of drug-metabolizing enzymes and ATP-binding cassette drug transporters can be one of the mechanisms behind CAM-anticancer drug interactions. Induction will often lead to therapeutic failure because of lower plasma levels of the anticancer drugs, and will easily go unrecognized in cancer treatment, where therapeutic failure is common.Recently identified nuclear receptors, such as the pregnane X receptor, the constitutive androstane receptor, and the vitamin D-binding receptor, play an important role in the induction of metabolizing enzymes and drug transporters. This knowledge has already been an aid in the identification of some CAM probably capable of causing interactions with anticancer drugs: kavakava, vitamin E, quercetin, ginseng, garlic, β-carotene, and echinacea. Evidently, more research is necessary to prevent therapeutic failure and toxicity in cancer patients and to establish guidelines for CAM use. The Oncologist 2006;11:742-752 Learning ObjectivesAfter completing this course, the reader will be able to:1. Describe the possible pharmacokinetic interactions between complementary alternative medicines and oncolytic drugs and the clinical consequences thereof.2. Define the role of the nuclear receptors PXR, CAR, and VDR in herb-drug interactions.3. Discuss methods to measure induction of drug-metabolizing enzymes and transporters.Access and take the CME test online and receive 1 AMA PRA Category 1 Credit

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“…Herb-drug interactions, the form of adverse effect most often mentioned by oncologists, has been the subject of a number of reviews [38][39][40][41][42]. Despite these reviews and the concerns they raise, only two articles were identified that specifically tried to assess the degree of risk encountered by use of dietary supplements, including herbs, during cancer care [41,43].…”

Section: Risks Of Alternative Cancer Carementioning

confidence: 99%

“…Despite these reviews and the concerns they raise, only two articles were identified that specifically tried to assess the degree of risk encountered by use of dietary supplements, including herbs, during cancer care [41,43]. Of the 76 chemotherapy patients surveyed to identify potentially negative chemotherapy-herb or vitamin interactions, only three of the patients were using herbs (St. John's wort or Hypericum perforatumy and garlic or Allium sativum) that might have affected the metabolism of their chemotherapy.…”

Section: Risks Of Alternative Cancer Carementioning

confidence: 99%