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Oncology > Botanical Therapeutics > Flashcards

Botanical Therapeutics Flashcards

1
Q

How are botanicals used in integrative oncology? (5)

A
  1. Chemoprevention
  2. Adjunt to midigate side effects of chemo/ radiation
  3. Adjunt to enhance effectiveness of chemo/ radiation
  4. Prevention of recurrence
  5. Improve QOL during survivorship
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2
Q

How are botanicals used in integrative oncology? (5)

A
  1. Chemoprevention
  2. Adjunt to midigate side effects of chemo/ radiation
  3. Adjunt to enhance effectiveness of chemo/ radiation
  4. Prevention of recurrence
  5. Improve QOL during survivorship
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3
Q

Ashwaganda scientific name

A

Withania somnifera

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4
Q

Ashwaganda mechanism

A

Constituents (withanolides, withaferin A) are antineoplastic
May be immunostimulatory, radiosensitizing (animal studies)

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5
Q

Ashwaganda evidence

A
  • Less fatigue and higher QOL, possibly better overall survival in breast cancer when combined with chemo
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6
Q

Ashwaganda dose

A

2 g TID

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7
Q

Ashwaganda interactions

A

May increase testosterone, avoid in prostate cancer

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8
Q

Astragalus indication in oncology

A

Prevent chemo-induced immunosuppression

May potentiate chemo, improve fatigue and anorexia

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9
Q

Astragalus key studies

A

Reduced risk of death at 12 mo, improved tumor response, stable or improved performance status (in chinese formula, when combined with platinum based chemo in NSCLC)

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10
Q

Astragalus dosage

A

1000 mg of extract standardized to 3% astraglosides, 2-3x/day

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11
Q

Astragalus interactions (3)

A
  1. Immunotherapy - may increase side effects (PD-1 inhibitors) or antagonize effects (corticosteroids)
  2. P-glycoprotein substrates - can inhibit efflux pump function increasing cytoxicity of chemo (doxorubicine, etoposide, vincristine *)
  3. Gemcitabine - affects pharmacokinestics in mouse model
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12
Q

Ginger mechanism

A

Competetive antagonism at 5-HT3 receptors

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13
Q

Ginger evidence

A

Meta-analysis - 0.71 OR controlling CINV (especially acute)
Large trial - decreased CINV in patients who had nausea in previouc cycles (with 5-HT3 antagonist)
- 0.5 and 1 g most effective

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14
Q

Ginger dosage

A

500-2000 mg daily

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15
Q

Ginger a/e

A

rare; low-grade GI, flushing, dermatitis

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16
Q

Ginger interactionts

A

unlikely

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17
Q

Ginger cautions

A

May increase bleeding; be cautious w/ blood thinners

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18
Q

Panax ginseng has been used in which cancers and side effects?

A

NSCLC, gastric cancer, esophageal cancer, cancer related fatigue (800 mg)

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19
Q

Panax ginseng effect on NSCLC?

A

Genseoside Rg3 combined with chemo - may enhance response, overall survival, alleviave side effects
poor quality trials

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20
Q

Panax ginseng effect on gastric cancer?

A

Ginsenoside Rg3 with Mitomycin C + Tegafur chemo after surgery - sig longer survival

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21
Q

Panax ginseng effect on esophageal cancer?

A

No difference in tumor response w/ gencitabine and cisplatin
inhibits new angiogenesis, reduced chemo side effects, improve QOL

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22
Q

Panax ginseng effect on cancer-related fatigue?

A

800 mg improved fatigue, QOL, appetite, and sleep

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23
Q

Panax quinquefolius dose and effect on cancer-related fatigue?

A

2000 mg daily after 8 weeks improves

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24
Q

Panax quinquefolius is effective for…?

A

reducing moderate to severe infections and sxs severity for respiratory infections in pts with chronic lymphocytic leukemia

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25
Q

Ginseng adverse effects

A

Stimulating - dry mouth, tachycardia, N/V diarrhea, insomnia, nervousness

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26
Q

Ginseng interactions

A

MAO inhibitors, warfarin, antidiabetics
Antineoplastic agents metabolized via CYP3A4
Imatinib-associated hepatotoxicity (case report)

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27
Q

Ginseng contraindications

A

Hormone-sensitive cancers (estrogenic)

1 week prior to surgery

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28
Q

Green tea active constituents are name and actions?

A

epicatechin, ECG, EGC, ECGC

potent antioxidants

29
Q

Green tea interferes with which steps of carcinogenesis and metastasis? (4)

A
  1. Prevention of oncogene and tumor initiation
  2. Inhibition of tumour production via apoptosis
  3. Inhibition of tumor progression
    4, Inhibition of tumour invasion and metastasis
30
Q

How does green tea prevent oncogene formation and tumour initiation? (4)

A
  1. Inhibits metabolic activation of procarcinogens
  2. Induces phase 2 conjugation for improved detox
  3. Quenches free radicals
  4. Modulates DND repair mechanisms
31
Q

How does green tea inhibit tumour promotion? (3)

A
  1. inhibits TNF-alpha release from neoplastic cells
  2. Inhibits telomerase activity
  3. Downregulates cyclin D1 and cyclin-dependent kinase
32
Q

How does green tea inhibit tumour progression? (2)

A
  1. Induces cell cycle arrest through inhibition of mitotic signalng
  2. Inhibits angiogenesis by altering intracellular signaling and decreasing VEGF production
33
Q

Green tea key studies

A 
Inverse association of 5-10 cups and risk of GI, esophageal (women), lung (non-smoking women) ovarian, prostate, and breast cancer 
>3 cups day associated with reduced recurrence in stage 1, 2 
ECGC supplement (2000 mg) BID reduces lymphadenopathy and reduces lymphocyte count in CLL
34
Q

Green tea dosage

A

5-10 cups daily or 1000-2000 mg catechins

35
Q

Green tea adverse effects

A

> 5 litres day may cause N/V, abdominal bloating and pain, dyspepsia, flatulence, diarrhea

36
Q

Green tea interactions

A

May be chemo and radiosensitizing
May also interfere with cytoxicity (bortexomib)
May increase bioavailability (tamoxifen) and prolong half-life (irinotecan)
ECGC reduce efficacy of radiation on prostate cancer
Inhibits CYP3A4
Possibility of hepatotoxicity

37
Q

Curcumin actions

A

Anti-inflam, antioxidant, hepatoprotective, antimicrobial, anticarcinogenic,

38
Q

Curcumin mechanisms (6)

A
  1. inhibition of inflammation via NF-kappaB and COX-2
  2. Inhibits of DNA adduct formation via antioxidant
  3. Promotion of apoptosis via increasing p53/ BAX, altering Bcl2
  4. Inhibition of angiogenesis via VEGF
  5. Decreasing cellular proliferation and motility
  6. Possibly synergism with chemo and radiation
39
Q

Curcumin key trials on cancer

A

8 g curcumin w/ gemcitabine-resistant pancreatic cancer increased survival time
May slow progression of MGUs and SMM

40
Q

Curcumin key trials on chemo/ radiation side effects

A

2 g TID reduced radiation-induced dermatitis in breast cancer
reduced adverse effects in various cancers

41
Q

Curcumin dosage

42
Q

What substance increases absorption of curcumin?

43
Q

Curcumin adverse effects

A

Up to 12 g - diarrhea, yellow stool, headache, rash

Binds iron

44
Q

Curcmin inhibits the cytotoxic effects of which agents?

A

Adriamycin, camtothecin, mechlorethamin (breast cancer in vitro), cyclophosphamide (breast cancer in mice )

45
Q

Which agents are known to be safe to combine with curcumin?

A

Docetaxel (breast and colon), FOLFOX (colon)

46
Q

Other curcumin cautions

A

interactions with P-glycoprotein substrates, cytochrome P450 enzymes
Suppresses platelet agregation
Some believe it’s estrogenic

47
Q

Curcumin CI

A

biliary duct obstruction, gallstones

48
Q

How do medicinal mushrooms likely work?

A

Immunomodulatory effects - enhances innate imunity and tumor specific adaptive immunity
Activate NK, T, B, and macrophage immune system responses

49
Q

What are the immunomodulatory effects of medicinal mushrooms d/t?

A

beta-1-3,1-6-D-glucans

50
Q

What is the scientific name for Coriulus/ Turkey Tail?

A

Trametes versicolor

51
Q

What are the two proteoglycan constituents of coriulus?

A

polysaccharide-krestin (PSK) and polysaccharopeptide (PSP)

52
Q

Coriolus mechanism

A

PSK enhances TNF-alpha, IFN-gamma, IL-2, IL-8, IL-12 concentrations
PSP increases leukocyte and neutrophil counts, serum IgG and IgM in NSCLS

53
Q

Coriolus key studies

A

PSK + radiation in esophageal - increased surivival
PSK + immunotherapy = increased survival, disease-free survival in resected
colorectal, gastric
PSK + chemo/ radiation = increased survival in lung

54
Q

Coriolus dose

A

3 d daily

Ideally, 1500 mg BID away from food

55
Q

Coriolus max safe dose

56
Q

Coriulus interactions

57
Q

Reishi scientific name

A

Ganoderma lucidum

58
Q

Reishi mechanism

A

Induces NK against cancer cell lines via cytotoxic receptors and MAPK signaling
Increase expression of MHC I on melanoma -
Inhibits ovarian cancer cells via VEGF suppression

59
Q

Reishi key studies

A

Reishi + chemo/ radiation = better response, relatively improved QOL
Improved host immune function indicators

60
Q

AHCC comes from which mushrooms?

A

Several species of Basidiomycete, includine shittake (Lentinus)

61
Q

AHCC key studies

A

Improves prognosis after resection of hepatocellular
Reduce chemo a/e and improve QOL in advanced cancer
Stabilize PSA doubling time in early prostate
Eliminate HPV infections?

62
Q

AHCC dosage

63
Q

AHCC a/e

A

Diarrhea and itching

64
Q

AHCC interactions

A

Induces CYP 2D6, which can decrease drug activity (doxorubicin, ondansetron)

65
Q

White Button Mushroom scientific name

A

Agaricus bisporus

66
Q

Agaricus key studies

A

decrease PSA in biochemically recurrent prostate cancer

Inhibit aromatase activity

67
Q

How are high quality mushrooms extracts made?

A

Using liquid fermentation - mycelium are grown in sterilized liquid nutrient media under stable temperature

68
Q

What’s the difference between high and low quality mushroom products?

A

Low quality are grown on rice and contain marginal beta glucan concentrations

Oncology (7 decks)

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