TABLE 2.

Summary of Relevant Case Reports and Clinical Trials

AGENT	CANCER TYPE	STUDY TYPE	AUTHOR (YEAR)	OBSERVATIONS
Vitamin E Gingko Ginseng Huang qi	Breast	Case Report	Norred et al. (2000)30	Patient had extensive postoperative bleeding requiring surgical re-exploration following vitamin E, gingko, ginseng and huang qi ingestion when combined with the drugs quinine sulfate and sertraline hydrochloride
Licorice	Prostate	Case Report	Cheng et al. (2004)32	An elderly Korean male presented with hypokalemic paralysis. He consumed eight packs (100 ml/pack) of a Korean herbal tonic daily to treat his prostate cancer for the previous 2 months. A significant amount of glycyrrhizic acid (0.23 mg/ml), an active ingredient of licorice, was detected in the tonic
Amygdalin Vitamin C	Uroepithelial carcinoma of the bladder	Case Report	Bromley et al. (2005)35	A 68-year-old patient ingested (3 g) of amygdalin and used 4800mg vitamin C presented to the ER with cyanide toxicity requiring intubation and ventilation
Agarics blazei	Ovarian	Case Report	Mukai et al. (2006)48	A 66-year-old female with stage IIIC ovarian cancer A 58-year-old female with stage IIIA breast cancer A 48-year-old female with metastatic breast cancer in the bone who was also a chronic hepatitis B carrier with normal liver transaminase values prior to chemotherapy All showed severe hepatic damage and two died of fulminant hepatitis
Ginseng Selenium	Lung	Case Report	Hwang et al. (2008)49	A 36-year-old female with adenocarcinoma of the lung ingested multiple complementary herbal medicines, including ginseng and selenium along with gefitinib, experienced continued disease progression with concurrent CAM use. A partial treatment response was obtained upon cessation of CAM use
Nerium oleander	Metastatic synovial carcinoma	Case Report	Altan et al. (2009)37	A 43-year-old female undergoing Ifosfamide and etoposide treatment with concurrent daily injections of Nerium oleander (Anvirzel™, Phoenix Biotech, Mississauga, Ontario) at 1.2mL/m2/day for 2 months developed hepatotoxicity, worsening ascites and disseminated intravascular coagulation with death due to cardiopulmonary arrest
St. John’s Wort	Colorectal, Lung, Sarcoma	Clinical Trial (N=6)	Arnold et al. (2002)42	Systemic exposure to SN-38, an active metabolite of irinotecan, decreased by about 42% when St. John’s wort was taken in conjunction with irinotecan.
Mistletoe	Breast, Ovarian, Non-small cell lung	Clinical Trial (N=233)	Piao et al. (2004)39	Seven non-serious adverse events which did not require therapeutic intervention and one serious adverse event (angioedema) were reported.