Table 1.
Most common CAM interventions adopted by cancer patients and possible interactions with AC.
| CAM agents | Metabolic pathway | Interaction with cancer treatments | Adverse events | Reference |
|---|---|---|---|---|
| Active hexose-correlated compound isolated from shiitake mushrooms | CYP2D6 induction | May reduce the activity of ADM, which is a substrate of this enzyme, and of AIs | Diarrhea and itching | (15) |
| Ananas Pineapple (bromelain) | CYP2C9 inhibition | Risk of overdosage in patients treated with TXL | Exacerbation of hand and foot syndrome | (16) |
| β-carotene | Alcohol consumption has an adverse effect on β-carotene activity | The hepatotoxic effects of ethanol may be potentiated by high-dose β-carotene | (17) | |
| B-elemene (terpene from Rhizoma zedoariae and mint) | Increased DDP and taxane activity | No adverse events recorded | (18) | |
| Bitter melon (Momordica charantia) | P-gp and CYP2C9 inhibition | Increased intracellular concentration VBL and TXL | No adverse events were recorded | (19) |
| Turmeric (Curcuma longa) | Weak CYP1A2, CYP2B6, CYP2C9, and CYP2D6 inhibition | Risk of overdosage in patients treated with bendamustine and inefficacy of prodrugs (CTX, TAM) | Allergic dermatitis and bile duct obstruction | (20) |
| Cannabinoids | CYP2C9 induction | Risk of overdosage in patients treated with prodrugs (CTX, TAM) | Gastrointestinal complaints∧ | (21) |
| Di Bella multitherapy§ | GH inhibition, enhances IGF-binding protein-1 secretion | The opioid antagonist properties of somatostatin reduce the analgesic effect of opioids in patients with advanced cancer | Gastrointestinal complaints∧, cholelithiasis, and hyperglycaemia | (22) |
| Echinacea | Potent CYP3A4 inhibition | Improved pharmacokinetics of CTX, DAS, TXT, ERL, IMT, SOR (weak) VALK (high), and VP16 | Severe thrombocytopaenia in a patient receiving VP16 | (23) |
| Essiac* | CYP3A4 inhibition | Risk of overdosage in patients treated with BTZ, DAS, TXT, ERL, IMT, SOR, VALK | Gastrointestinal complaints∧ | (24) |
| Folic acid | MTHFR-enhancing activity | Improved activity of antimetabolite drugs (5-Fu) | Concurrent use of folic acid may antagonize the effects of certain anticonvulsants | (25) |
| Glucans from mushrooms° | EGFr and mTOR inhibition | May antagonize TAM in patients with estrogen-positive breast cancer | Immunosuppressive effects | (26) |
| Green tea | CYP3A4 inhibition | Similar to Essiac | High ALT levels | (27) |
| Gingko biloba | CYP3A4 CYP2C19, P-gp | Similar to Essiac | Nervousness | (28) |
| Ginseng | CYP3A4 inhibition | Increased risk of IMT hepatotoxicity | High ALT levels | (29) |
| Glutathione | GSH, GSTP1 | Increased AC detoxification | Mucosal hypersecretion | (30) |
| Grapefruit (including juice) | CYP3A4 inhibition | Not recommended during ADM due to oxidations | Gastrointestinal complaints∧ | (31) |
| Liquorice | weak CYP2B6, CYP3A4 inhibition | Similar to Essiac (weak) | Hypertension, retinopathy and nephropathy | (32) |
| Milk thistle | Weak CYP2C8 and CYP2C9 inhibition | Risk of overdosage in patients taking CTX, TXL | No adverse events recorded | (33) |
| Oleander | P-gp and mTOR inhibition | May increase the blood levels of substrate drugs such as TKIs. | Gastrointestinal complaints∧ | (34) |
| Omega 3 | p53 | Reduces platin activity | Platin-drug resistance | (35) |
| Ozone therapy | ND | Not recommended during ADM due to oxidation | ND | (36) |
| Quercetin | Strong CYP3A4 and CYP2C19 inhibition | Similar to Essiac | High ALT levels | (37) |
| Resveratrol | CYP3A4, CYP2D6, CYP2C9, inhibition | Protective effects against DDP- and ADM-induced cardiotoxicity, due to upregulation of SIRT1-mediated p53 deacetylation | No adverse events recorded | (38) |
| Spirulina and blue-green algae | CYP 1A2 and 2E1 inhibitions | Induces accumulation of drugs metabolized by these enzymes, including bendamustine | Increases the risk of their side effects | (39) |
| St. John's worth (Hypericum) | CYP3A4 induction | Improved CTX, DAS, TXT, ERL, IMT, SOR, and VALK pharmacokinetics | Headache, dry mouth, sleepiness, gastrointestinal complaints∧ | (40) |
| Vitamin C | ND | May reduce the effectiveness of VCR, ADM, MTX, DDP, BTZ, IMT | Kidney stones | (41) |
| Zeolite | Protein kinase B inhibition | Enhances the effect of ADM due to its antioxidant properties | Pulmonary fibrosis, leucocytosis | (42) |
AC, Antiblastic chemotherapy; ADM, Doxorubicin; ALT, Alanine aminotransferase; BTZ, Bortezomib; CTX, Cyclophosphamide; CYP, Cytochrome P450; DAS, Dasatinib; DDP, Cisplatin; ERL, Erlotinib; 5-FU, Fluorouracil; IA, Aromatase inhibitors; IMT, Imatinib; MTX, Methotrexate; NA, Not available; ND, Not documented; P-gp, P-glycoprotein; SOR, Sorafenib; TAM, Tamoxifen; TXL, Paclitaxel; TXT, Docetaxel; VALK, Vinca alkaloids; VBL, Vinblastine; VCR, Vincristine; VP16, Etoposide.
Source:http://reference.medscape.com/drug-interactionchecker and Memorial Sloan Kettering Cancer Center: https://www.mskcc.org/cancer-care/integrative-medicine/herbs/ginseng-asian#references-24.
Herbal mixture patented as a cancer therapy by Rene Caisse in 1920 in Canada.
Grifula frondosa (maitake), Lentinula edodes (shiitake), Ganoderma lucidum (reishi), etc.
Somatostatin, Bromocriptine, Fluvoxamine, Melatonin.
Gastrointestinal complaints: diarrhea, vomiting, and nausea.