Appendix C: Herbal Supplements Flashcards
Aloe
May be used for constipation as aloe juice and aloe vera gel
Can help with radiation dermatitis in patients with H&N cancer
Radiation proctilitis improved in those who used aloe vera
a-Lipoic acid
Food sources: Broccoli and Spinach
cellular antioxidant that is important for energy production
Helps improve insulin sensitivity and diabetes management
May reduce symptoms of neurotoxicity with oxaliplatin and cisplatin
Inhibits growth of breast, colon, lung, liver and pancreatic CA cells
Used orally or given IV to help improve fasting glucose in patients with T2DM
black cohosh
Suppresses symptoms of hot flashes associated with menopause and CA treatments (hormonal)
Possibly not safe with pregnancy or lactation
Can interfere with Tamoxifen and increase toxice effects of doxorubicin and docetaxel
coenzyme Q10
Fat soluble substance found in every cell of the body
Endogenous antioxidant involved in cellular energy production
Low plasma levels are associated with increased risk of breast CA and melanoma
May reduce:
- renal and cardiotoxicity associated with Doxorubicin.
- radiation induced nephropathy
- renal toxicity associated with doxorubicin and carboplatin
Contraindicated if taking Warfarin
curcumin
Safe
naturally occurring polyphenol found in the Tumeric plant
Anti- inflammatory, antioxidant, anticancer properties, may inhibit growth of cancer cells
Shown to have therapeutic effects in: lung, cervical, prostat, breast, osteosarcoma, liver, esophagea, and gastric cancers
May enhance anticancer effect of 5FU, and combo of 5FU and Cisplatin
Improves myelosuppression induced by carboplatin
Reverses resistance to irinotecan in colon cancer cells
may increase efficacy of cisplatin to tumors cells that were cisplatin resistant and reduces neurotoxicity
Works better when combined with black pepper
3,3-Diindolylmethane (DIM) and indole-3-carbinol (I3C)
bioactive metabolite found in cruciferous vegetables
DIM and I3C affect multiple signalling pathways and target molecules controling cell division apotosis and angiogenesis
May interfer with hormonal therapy d/t potential antiestrogenic effects
Reduced doxorubicin induced oxidative stress in cardiac tissues by reducing leves of free radicles and lipid peroxidation
enhanses therapeutic efficacy of paclitaxel in gatstric cancer
flaxseed
excellent source of alpha linolenic acid and rich in lignands
source of soluble and insoluble fiber
phytoestrogenic and antioxidant properties
Increases markers of apoptosis and decreases cancer cell proliferation
may inhibit growth of breast and prostate cancer
Consuming 25 grams of flaxseed daily may reduce cancer growth in wemone with breast cancer
must be ground to show biologic effects
1-2 Tbsp/day safe
may cause possible: nausea, gas, diarrhea
garlic
may stimulate apoptosis and help regulate cell cycles
a study looking at the effect of garlic extract found that cell proliferation was reduced by 80% in all cell types (breast, prostate, colon)
garlic is associated with lower risk of gastric cancer
ginger
may help nausea, heartburn, anorexia, diarrhea and gas
has antioxidant and anti-inflammatory properties
may inhibit angiogenesis
Ginger juice and acetone extract of ginger reversed delayed gastric emptying 2/2 to cisplatin therapy
Mixed evidence on effect of ginger on N/V
ginkgo biloba
may inhibit proliferation of cancer cells
may reduce toxicity of cisplatin
may help enhance tumor reduction with tamoxifen
May inhibit activity with anticoagulants and anti-seizure medicines
glutamine
most abundant non-essential amino acid in the body
- involved in cell cycle replication for rapid cell turnover in the GI mucosa and immune system
- may reduced inflammatory side effects of cancer treatment (mucositis, stomatitis, esophagitis, diarrhea)
- helps maintain mucosal barrier
-15 grams 2x/day for 7 days following oxaliplatin reduces peripheral neuropathy and severity
- evidence not as great for use in auto HCT
- contraindicated with antiseizure medication and lactulose
green tea
- antiobesity, anticancer, anti bacterial antiviral, hepatoprotective, cardoprotective, and neuroprotective benerfits
- demonstrated to inhibit tumorigienesis in animal modals
variety of drug interactions d/t inhibitory effects of Cytochrome P-450 izozymes
**should not be taken with Tarceva (erlotinib) and Votrient (pazopanib) and Velcade
melatonin
-sleep aid
-may increase effects of herbs with anitcoagulant products, so in theory could increase risk of bleeding
-possibly help with some chemos: increase effect of Oxaliplatin, cisplatin, 5-FU, gemcitabine, tamoxifen
-might help/limit development neuropathic pain
generally safe and well tolerated — 1-5 mg/d for insomnia and up to 20 mg/d for anticancer effects
N-acetylcysteiene (NAC)
Antioxidant that contains thiol groups–stimulates glutathione synthesis and scavengers free radicals
-can improve chemo by enhancing cytotoxic effects of the chemo and protecting the host tissues—cisplatin, 5-FU, cyclophosphamide, ifosfamide, methotrexate, oxaliplatin, doxorubicin, combined carbo, melphanin, and etoposide phosphate
generally safe and well tolerated with minimal side effects
600-1800 mg/day.
Omega-3s — EPA and DHA
cardioprotective, anti-inflammatory and immunomodulatory effects, may reduce inflammation
Might help with breast cancer and endometrial cancer risk.
Might help with neuropathy with paclitaxel.
Might enhance doxorubicin, cisplatin, vincristine (omega 3) and combo of oxaliplatin and 5-FU (EPA)
Omega-3 from food is best. EPA/DHA up to 3 g/day is considered safe. no more than 4 g/day but need MD monitoring for bleeding risk
Quercetin
Flavonoid in foods and tea, also supplement
anti-inflammatory, induces apoptosis in breast cancer cells
more studies are needed for safety and tolerability when used IV—side effects of flushing, sweating, N/V and dyspnea reported
can bind with iron and therefore decrease bioavailability - possibly increasing iron deficiency in vulnerable individuals undergoing treatments. though it might be beneficial for patients at risk of hemochromatosis
oral is safe and well tolerated in foods (citrus, apples, onions, parsley, tea)
Reishi mushroom
bioactive compounds, such as polysccharides, triterpenoids, alkaloids, enzymes and protein.
Used to prevent aging, enhance the immune system, and treatment for HTN, high lipids, viral infections like flu, cancer, inflammatory disease, CVD, DM, asthma and bronchial diseases
possibly unsafe when used in powdered form for more than 1 month
may increase risk of bleeding when combined in high doses (>3 g/day) with anticoagulant meds
one small study found 1000 mg powder, 3-4 times/day for 4 weeks, helped with cancer related fatigue in breast cancer patients on endocrine therapy
no evidence to support front line treatment but could be used to enhance tumor response and host immunity – in caution.
most studied mushroom with respect to hepatoprotective effects
resveratrol
phytoestrogen, antioxidative, anti-inflammatory, antimutagenic
has antiplatelet effects, so could cause excessive bleeding in persons on blood thinners
found possibly effective in many cancers
can reduce cisplatin renal toxicity
possible radiosensitizer of breast cancer cells
might help prevent bone loss with methotrexate (1 mg/kg body weight)
root of knotweed (polygunum) is a rich sources. Grapes (black more than red or green)–grape skins
selenium
cofactor for glutathione peroxidase, an enzyme of antioxidant defense system
excessive amounts can cause acute toxicity – N/V, abd pain, dermatitis, nail changes, fatigue, irritability, alopecia, impaired endocrine function, neurotoxicity and wt loss
Most research suggests selenium does NOT reduce risk of cancer
Might enhance effects of cisplatin on breast cancer
may help with taxol and etoposide
might help with docetaxel in breast
might mitigate potential for 5-FU induced mucositis
Orally selenium is safe and well tolerated in dosages up to Tolerable Upper Intake Level of 400 mcg/d
silymarin (milk thistle)
antioxidant, immunomodulatory effects, anti-inflammatory effects, liver-protective, anti-cancer
allergic reactions reported in >1,500 mg/d
CAUTION with tamoxifen
might reduce side effects of cisplatin (rat study) – not found to help with AKIs in cisplatin
might reduce severity of radiotherapy-induced mucositis and delay occurrence in ENT pts
Generally well tolerated
Better taken as Silybin-PC to improve bioavailability
St. john’s Wort
Herbal–yellow flower
may interact with many medications, including warfarin
possibly make colorectal cancer cells more responsive to treatment
not enough strong evidence to recommend for cancer treatments, particularly due to interactions with other meds
AVOID for all concurrent chemotherapy due to possible effects on enzyme inductions for multiple enzymes
Theanine
amino acid found in tea and mushrooms - antioxidant
may enhance efficiency of doxorubicin and idarubicin and reduce their side effects
few side effects, but might lower BP (interact with HTN meds)
no evidence that taking supplements is more effective than drinking it in tea – common dosage is 200 to 400 mg daily or BID, max 1,200 mg
Turkey tail mushrooms
antimicrobial, antiviral, immunomodulatory, antitumor — big in Ancient Chinese Formulations/medicine
low incidence of mild/tolerable side effects
found might help with survival for cancer, particularly breast, gastric, and colorectal, and lung.
might help reduce radiation side effects
safe/well tolerated
dosage is 3 g of extract/day
vitamin D
regulate genes that influence cell proliferation/apoptosis
toxicity–can result in hypercalcemia
studies back/forth on low Vit D and increased cancer risk and vise versa
Important for overall health, including cancer prevention
bioavailability of D3 (cholecalciferol) is greater than D2 (ergocalciferol)
Upper level revised to 4000 IU/d
Endocrine Society recommends maintaining 25-hydroxyvitamin D blood level of 40-60 ng/mL is ideal, up to 100 mg/mL is safe
