Oncology Reviews

, Volume 1, Issue 4, pp 233–242

Natural health products and cancer chemotherapy and radiation therapy



Complementary therapies, notably natural health products such as herbs and vitamins, are frequently used by cancer patients receiving chemotherapy and radiation therapy. There is much controversy as to whether these natural health products should be taken during conventional cancer treatments. Supporters of this practice cite beneficial effects of the antioxidant properties, while opponents are concerned about the potential for natural health product-chemotherapy/radiation related negative interactions. This involves understanding the role and effect on metabolizing enzymes. This review will highlight the present evidence for both the beneficial and negative consequences of the use of natural health products during chemotherapy and radiation therapy.

Key words

Natural health products Herbs Cancer Chemotherapy Radiation therapy 


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  1. 1.
    Ernst E, Cassileth BR (1998) The prevalence of complementary/alternative medicine in cancer: a systematic review. Cancer 83:777–782PubMedCrossRefGoogle Scholar
  2. 2.
    National Health Product Directorate (NHPD) Natural Health Products. 2006 Ottawa: Health CanadaGoogle Scholar
  3. 3.
    Seely D, Stempak D, Baruchel S (2007) A strategy for controlling potential interactions between natural health products and chemotherapy. A review in pediatric oncology. J Pediatr Hematol Oncol 29:32–47PubMedCrossRefGoogle Scholar
  4. 4.
    Ganz PA, Desmond KA, Leedham B, et al (2002) Quality of life in long-term disease-free survivors of breast cancer: a follow-up study. J Natl Cancer Inst 94:39–49PubMedGoogle Scholar
  5. 5.
    Bernstein HJ, Grasso T (2001) Prevalence of complementary and alternative medicine use in cancer patients. Oncology 15:1267–1272PubMedGoogle Scholar
  6. 6.
    Werneke U, Earl J, Seydel C et al (2004) Potential health risks of complementary alternative medicines in cancer patients. Br J Cancer 90:408–413PubMedCrossRefGoogle Scholar
  7. 7.
    Sparreboom A, Cox MC, Acharya MR, Figg WD (2004) Herbal remedies in the United States: potential adverse interactions with anticancer agents. J Clin Oncol 22:2489–2503PubMedCrossRefGoogle Scholar
  8. 8.
    Blumenthal RS, Becker DM, Yanek LR et al (2003) Detecting occult coronary disease in a high-risk asymptomatic population. Circulation 107:702–707PubMedCrossRefGoogle Scholar
  9. 9.
    Richardson MA, Sanders T, Palmer JL, Greisinger A, Singletary SE (2000) Complementary/alternative medicine use in a comprehensive cancer center and implications for oncology. J Clin Oncol 18:2505–2514PubMedGoogle Scholar
  10. 10.
    Dy GK, Bekele L, Hanson LJ, Furth A, Mandrekar S, Sloan JA, Adjei AA (2004) Complementary and alternative medicine use by patients enrolled onto phase I clinical trials. J Clin Oncol 22:4810–4815PubMedCrossRefGoogle Scholar
  11. 11.
    Burstein HJ, Gelber S, Guadagnoli E, Weeks JC (1999) Use of alternative medicine by women with early-stage breast cancer. N Engl J Med 340:1733–1739PubMedCrossRefGoogle Scholar
  12. 12.
    Vapiwala N, Mick R, DeNittis A, Hampshire M, Metz J (2005) Initiation of complementary and alternative medical therapies (CAM) by cancer patients during radiation therapy (RT). Proc Am Soc Ther Radiat Oncol 63(Suppl): S451Google Scholar
  13. 13.
    Gupta D, Lis CG, Birdsall TC, Grutsch JF (2005) The use of dietary supplements in a community hospital comprehensive center: implications for conventional cancer care. Support Care Cancer 13:912–919PubMedCrossRefGoogle Scholar
  14. 14.
    McCune JA, Hatfield AJ, Blackburn A, Leith PO et al (2004) Potential of chemotherapy-herb interactions in adult cancer patients. Support Care Cancer 12:454–462PubMedCrossRefGoogle Scholar
  15. 15.
    Cai Y, Luo Z, Sung M, Corke H (2004) Antioxidant activity and phenolic compounds of 112 traditional Chinese medicinal plants associated with anticancer. Life Sciences 74:2157–2184PubMedCrossRefGoogle Scholar
  16. 16.
    Lopaczynski W, Zeisel SH (2001) Antioxidants, programmed cell death, and cancer. Nutr Res 21:295–307CrossRefGoogle Scholar
  17. 17.
    Seifried HG, McDonald SS, Anderson DE et al (2003) The antioxidant conundrum in cancer. Cancer Res 63:4295–4298PubMedGoogle Scholar
  18. 18.
    Drisko JA, Chapman J, Hunter VJ (2003) The use of antioxidants during chemotherapy. Gynecol Oncol 88:434–439PubMedCrossRefGoogle Scholar
  19. 19.
    Conklin KA (2000) Dietary antioxidants during cancer chemotherapy: impact on chemotherapeutic effectiveness and development of side effects. Nutrition and Cancer 37:1–18PubMedCrossRefGoogle Scholar
  20. 20.
    Conklin KA (2004) Chemotherapy-Associated Oxidative Stress: Impact on Chemotherapeutic Effectiveness. Integr Cancer Ther 3:294–300PubMedCrossRefGoogle Scholar
  21. 21.
    Conklin KA (2004) cancer chemotherapy and antioxidants. J Nutrition 134:3201S–3204SGoogle Scholar
  22. 22.
    Lamson DW, Brignall MS (1999) Antioxidants in cancer therapy: their actions and interactions with oncologic therapies. Altern Med Rev 4:304–329PubMedGoogle Scholar
  23. 23.
    Lamson Dw, Brignall MS (2000) Antioxidants and cancer therapy II: quick reference guide. Altern Med Rev 5:152–163PubMedGoogle Scholar
  24. 24.
    Block KI (2004) Antioxidants and Cancer Therapy: Furthering the Debate. Integr Cancer Ther 3:342–348PubMedCrossRefGoogle Scholar
  25. 25.
    Lenzahofer R, Ganzinger U, Rameis H, Moser K (1983) Acute cardiac toxicity in patients after doxorubicin treatment and the effect of combined tocopherol and nifedipine pretreatment. J Cancer Res Clin Oncol 106:143–147CrossRefGoogle Scholar
  26. 26.
    Ladas EJ, Jacobson JS, Kennedy DD et al (2004) Antioxidants and cancer therapy: a systematic review. J Clin Oncol 22:517–528PubMedCrossRefGoogle Scholar
  27. 27.
    Prasad KN, Cole WC, Kumar B, Prasad KC (2001) Scientific Rationale for using high-dose multiple micronutrients as an adjunct to standard and experimental cancer therapies. J Am Coll Nutrition 20:450S–463SGoogle Scholar
  28. 28.
    Simone CBII, Simone NL, Simone V, Simone CB (2007) Antioxidants and other nutrients do not interfere with chemotherapy or radiation therapy and can increase kill and increase survival, Part 1. Alternative Therapies 13:22–28Google Scholar
  29. 29.
    Mandlekar S, Hong J-L, Kong AH (2006) Modulation of metabolic enzymes by dietary phytochemicals: a review of mechanisms underlying beneficial versus unfavorable effects. Current Drug Metabolism 7:661–675PubMedCrossRefGoogle Scholar
  30. 30.
    Epstein KR (2003) The role of carotenoids on the risk of lung cancer. Semin Oncol 30:86–93PubMedCrossRefGoogle Scholar
  31. 31.
    Vershinin AO, Kamnev AN (1996) [Mechanisms of antitumor activity of carotenoids]. Vopr Med Khim 42:275–277PubMedGoogle Scholar
  32. 32.
    Gordializa M, Castro MA, del Corral JM, Feliciano AS (2000) Antitumor properties of podophyllotoxin and related compounds, Curr Pharm Des 6:1811–1839CrossRefGoogle Scholar
  33. 33.
    Lai PK, Roy J (2004) Antimicrobial and chemopreventive properties of herbs and spices. Current Medicinal Chemistry 11:1451–1460PubMedGoogle Scholar
  34. 34.
    Mizutani K, Ikeda K, Kawai Y, Yamori Y (2001) Protective effect of resveratrol on oxidative damage in male and female stroke-prone spontaneously hypertensive rats. Clin Exp Pharmacol Physiol 28:55–59PubMedCrossRefGoogle Scholar
  35. 35.
    Timothy TO, Janice FW, Carl LK (2003) Chronic consumption of flavanol and procyanindin-rich diet is associated with reduced levels of 8-hydroxy-2-deoxyguanosine in rat testes. J Nutr Biochem 14:104–110CrossRefGoogle Scholar
  36. 36.
    Lee SH, Jung BH, Kim SY, Chung BC (2004) Determination of phytoestrogens in traditional medicinal herbs using gas chromatography-mass spectrometry. J Nutritional Biochem 15:452–460CrossRefGoogle Scholar
  37. 37.
    Dixon-Shanies D, Shaikh N (1999) Growth inhibition of human breast cancer cells by herbs and phytoestrogens. Oncol Rep 6:1383–1387PubMedGoogle Scholar
  38. 38.
    Yang CS, Landau JM, Huang MT, Newmark HL (2001) Inhibition of carcinogenesis by dietary polyphenolic compounds. Annu Rev Nutrition 21:381–406PubMedCrossRefGoogle Scholar
  39. 39.
    Lau CBS, Ho CY, Kim CF et al (2004) Cytotoxic activities of Coriolus versicolor (Yunzhi) extract on human leukemia and lymphoma cells by induction of apoptosis. Life Sciences 75:797–808PubMedCrossRefGoogle Scholar
  40. 40.
    Yip ECH, Chan ASL, Pang H et al (2006) Protocatechiuc acid induces cell death in HepG2 hepatocellular carcinoma cells through a c-Jun-N-terminal kinase-dependent mechanism. Cell Biol Toxicol 22:293–302PubMedCrossRefGoogle Scholar
  41. 41.
    Peng P-L, Hsieh Y-S, Wang C-J et al (2006) Inhibitory effect of berberine on the invasion of the human lung cancer cells via decreased productions of urokinase-plasminogen activator and matrix metalloproteinase-2, Toxicol Applied Pharmacol 214:8–15CrossRefGoogle Scholar
  42. 42.
    Jiang C, Lee H-J, Li G-X et al (2006) Potent antiandrogen and androgen receptor activities of an angelica gigascontaining herbal formulation: identification of decursin as a novel and active compound with implications for prevention and treatment of prostate cancer. Cancer Res 66:453–463PubMedCrossRefGoogle Scholar
  43. 43.
    Chen X, Hu Z-P, Yang X-X et al (2006) Monitoring of immune responses to a herbal immuno-modulator in patients with advanced colorectal cancer. Int Immunopharmacol 6:499–508PubMedCrossRefGoogle Scholar
  44. 44.
    Amiroghofran Z, Balunanii M, Azadmehr A, Javidnia K (2006) Induction of apoptosis in leukemia cell lines by Linum persicum and Euphorbia cheiradenia J Cancer Res Clin Oncolo 132:427–432CrossRefGoogle Scholar
  45. 45.
    Powell CB, Fung P, Jackson J et al (2003) Aqueous extract of herba Scutellaria barbatae, a chinese herb used for ovarian cancer, induces apoptosis of ovarian cancer cell lines. Gyneocol Oncol 91:332–340CrossRefGoogle Scholar
  46. 46.
    Ko S-G, Koh S-H, Jun C-Y et al (2004) Induction of Apoptosis by Saussurea lappa and Pharbitis nil on AGS Gastric Cancer Cells. Biol Pharm Bull 27:1604–1610PubMedCrossRefGoogle Scholar
  47. 47.
    Lee H-J, Lee E-O, Rhee Y-H et al (2006) An oriental herbal cocktail, kami-kae-kyuk-tang, exerts anti-cancer activities by targeting angiogenesis, apoptosis, and metastasis. Carcinogenesis 27:2455–2463PubMedCrossRefGoogle Scholar
  48. 48.
    Patel NM, Nozaki S, Shortle NH et al (2000) Paclitaxel sensitivity of breast cancer cells with constitutively active NF-kB is enhanced by IkappaBalpha super-repressor and parthenolide. Oncogene 19:4159–4169PubMedCrossRefGoogle Scholar
  49. 49.
    McCulloch M, See C, Shu X-J et al (2006) Astragalus-based Chinese herbs and platinum-based chemotherapy for advanced non-small-cell lung cancer: meta-analysis of randomized trials. J Clin Oncol 24:419–430PubMedCrossRefGoogle Scholar
  50. 50.
    Mok TSK, Yeo W, Johnson PJ et al (2007) A double-blind placebo-controlled randomized study of Chinese herbal medicine as complementary therapy for reduction of chemotherapy-induced toxicity. Ann Oncol 18:768–774PubMedCrossRefGoogle Scholar
  51. 51.
    Taixiang W, Wei X, Yang X, Zhiyu C (2007) Medicinal herbs for esophageal cancer (Review). Cochrane Database of Systematic Reviews, Issue 1Google Scholar
  52. 52.
    Taixiang W, Munro AJ, Guanjian L (2005) Chinese medical herbs for chemotherapy side effects in colorectal cancer patients (Review). Cochrane Database of Systematic Reviews, Issue 1Google Scholar
  53. 53.
    Shu Z, McCulloch M, Xiao H et al (2005) Chinese herbal medicine and chemotherapy in the treatment of hepatocellular carcinoma: a meta-analysis of randomized controlled trials. Integrative Cancer Therapies 4:219–229PubMedCrossRefGoogle Scholar
  54. 54.
    Rekha PS, Kuttan G, Kuttan R (2001) Effect of brahma rasayana on antioxidant system after radiation. Indian J Exp Biol 39:1173–1175PubMedGoogle Scholar
  55. 55.
    Puri HS (2003) Rasayana-Ayurvedic herbs for longevity and rejuvenation. Taylor and Francis, LondonGoogle Scholar
  56. 56.
    Govindarajan R, Vijayakumar M, Pushpangadan P (2005) Antioxidant approach to disease management and the role of ‘Rasayana’ herbs of Ayurveda. J Ethnopharmacol 99:165–178PubMedCrossRefGoogle Scholar
  57. 57.
    Pal D, Mitra AK (2006) MDR and CYP3A4-mediated drug-herbal interactions. Life Sciences 78:2131–2145PubMedCrossRefGoogle Scholar
  58. 58.
    Mandlekar S, Hong J-L, Kong AH (2006) Modulation of metabolic enzymes by dietary phytochemicals of mechanisms underlying beneficial versus unfavorable effects. Current Drug Metabolism 7:661–675PubMedCrossRefGoogle Scholar
  59. 59.
    Evans AM (2000) Influence of dietary components on the gastrointestinal metabolism and transport of drugs. Ther Drug Monit 22:131–136PubMedCrossRefGoogle Scholar
  60. 60.
    Ioannides C (2002) Pharmacokinetic interactions between herbal remedies and medicinal drugs. Xenobiotica 32:451–478PubMedCrossRefGoogle Scholar
  61. 61.
    Wilkinson GR (1997) The effects of diet, aging and disease-states on presystemic elimination and oral drug bioavailability in humans. Adv Drug Deliv Rev 27:129–159PubMedCrossRefGoogle Scholar
  62. 62.
    Block KI, Gyllenhaal C (2002) Clinical corner-herb-drug interactions in cancer chemotherapy: theoretical concerns regarding drug metabolizing enzymes. Integrative Cancer Therapies 1:83–89PubMedGoogle Scholar
  63. 63.
    Meijerman I, Jos H, Beijnnen, Jan HM Schellens (2006) Herb-drug interactions in oncology: focus on mechanisms of induction. The Oncologist 11:742–752PubMedCrossRefGoogle Scholar
  64. 64.
    Hardman JG, Limbird LE, Molinoff PB et al (1996) Goodman and Gilman’ The Pharmacological Basis of Therapeutics 9th Ed. McGraw Hill, New YorkGoogle Scholar
  65. 65.
    Watkins PB, Wrighton SA, Schuetz EG et al (1987) Identification of glucocorticoid-inducible cytochromes P-450 in the intestinal muscosa of rats and man. J Clin Invest 80:1029–1036PubMedCrossRefGoogle Scholar
  66. 66.
    Guengerich FP, Martin MV, Beaune PH et al (1986) Characterization of rat and human liver microsomal cytochrome P-450 forms involved in nifedipine oxidation, a prototype for genetic polymorphism in oxidative drug metabolism. J Biol Chem 261:5051–5060PubMedGoogle Scholar
  67. 67.
    Parkinson A (1996) An overview of current cytochrome P450 technology for assessing the safety and efficacy of new materials. Toxicol Pathol 24:48–57PubMedCrossRefGoogle Scholar
  68. 68.
    Chen CJ, Chin JE, Ueda K et al (1986) Internal duplication and homology with bacterial transport proteins in the mdr1 (P-glycoprotein) gene from multidrugresistant human cells. 47:381–389Google Scholar
  69. 69.
    Leslie EM, Deeley RG, Cole SP (2001) Toxicological relevance of the multidrug resistance protein 1 MRP1 (ABCC1) and related transporters. Toxicology 167:3–23PubMedCrossRefGoogle Scholar
  70. 70.
    Weinstein RS, Kuszak JR, Kluskens LF, Coon JS (1990) P-glycoproteins in pathology: the multidrug resistance gene family in humans. Hum Pathol 21:34–48PubMedCrossRefGoogle Scholar
  71. 71.
    Ambudkar SV, Dey S, Hrycyna CA et al (1999) Biochemical, cellular, and pharmacological aspects of the multidrug transporter. Annu Rev Pharmacol Toxicol 39:361–398PubMedCrossRefGoogle Scholar
  72. 72.
    Lin JH, Yamazaki M (2003) Role of P-glycoprotein in pharmacokinetics: clinical implications Clin Pharmacokinet 42:59–98PubMedCrossRefGoogle Scholar
  73. 73.
    Yu DK (1999) The contribution of P-glycoprotein to pharmacokinetic drug-drug interactions J Clin Pharmacol 39:1203–1211PubMedCrossRefGoogle Scholar
  74. 74.
    Cole SP, Bhardwaj G, Gerlach JH et al (1992) Overexpression of a transporter gene in multi-drug-resistant human lung cancer cell line. Science 258: 1850–1654Google Scholar
  75. 75.
    Deeley RG, Cole SP (1997) Function, evolution, and structure of multidrug resistance protein (MRP). Semin Cancer Biol 8:193–204PubMedCrossRefGoogle Scholar
  76. 76.
    Gottesman MM, Pastan I (1993) Biochemistry of multidrug resistance mediated by the multidrug transporter. Annu Rev Biochem 62:3385–3427CrossRefGoogle Scholar
  77. 77.
    Litman T, Druley TE, Stein WD, Bates SE (2001) From MDR to MXR: new understanding of multidrug resistance systems, their properties and clinical significance. Cell Mol Life Sci 58:931–959PubMedCrossRefGoogle Scholar
  78. 78.
    Borst P, Elferink RO (2002) Mammalian ABC transporters in health and disease. Annu Rev Biochem 2002; 71:537–592PubMedCrossRefGoogle Scholar
  79. 79.
    Schinkel AH, Jonker HW (2003) Mammalian drug efflux transporters of the ATP binding cassette (ABC) family: an overview. Adv Drug Deliv Rev 55:3–29PubMedCrossRefGoogle Scholar
  80. 80.
    Sparreboom A, Danesi R, Ando Y, Chan J, Figg WD (2003) Pharmacogenomics of ABC transporters and its role in cancer chemotherapy. Drug Resist Update 6:71–84CrossRefGoogle Scholar
  81. 81.
    Blumberg B, Sabbagh W Jr, Juguilon H et al (1998) SXR, a novel steroid and xenobiotic-sensing nuclear receptor. Genes Dev 12:3195–3205PubMedCrossRefGoogle Scholar
  82. 82.
    Mathijsen RH, Verweij J, de Bruin P et al (2002) Effects of St. John’s wort on irinotecan metabolism. J Natl Cancer Inst 94:1247–1249Google Scholar
  83. 83.
    Frye RF, Fitzgerald SM, Lagattuta TF et al (2004) Effect of St. John’s wort on imatinib mesylate pharmacokinetics. Clin Pharmacol Ther 76:323–239PubMedCrossRefGoogle Scholar
  84. 84.
    Smith P, Bullock JM, Booker BM et al (2004) The influence of St. John’s wort on the pharmacokinetics and protein binding of imatinib mesylate. Pharmacotherapy 24:1508–1514PubMedCrossRefGoogle Scholar
  85. 85.
    Komoroski BJ, Parise RA, Egorin MJ et al (2005) Effect of the St. John’s wort constituent hyperforin on docetaxel metabolism by human hepatocyte cultures. Clin Cancer Res 11:6972–6979PubMedCrossRefGoogle Scholar
  86. 86.
    Tabb MM, Kholodovych V, Grun F et al (2004) Highly chlorinated PCBs inhibit the human xenobiotic response mediated by the steroid and xenobiotic receptor (SXR). Environ Health Perspect 112:163–169PubMedGoogle Scholar

Copyright information

© Springer 2008

Authors and Affiliations

  1. 1.Unit 43Grey Nuns HospitalEdmontonCanada
  2. 2.Division of Palliative Medicine, Department of OncologyUniversity of AlbertaEdmontonCanada
  3. 3.FRCPC, Medical Oncologist, London Regional Cancer ProgramUniversity of Western OntarioLondonCanada

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