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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
Ginseng adverse effects
Stimulating - dry mouth, tachycardia, N/V diarrhea, insomnia, nervousness
26
Ginseng interactions
MAO inhibitors, warfarin, antidiabetics Antineoplastic agents metabolized via CYP3A4 Imatinib-associated hepatotoxicity (case report)
27
Ginseng contraindications
Hormone-sensitive cancers (estrogenic) | 1 week prior to surgery
28
Green tea active constituents are name and actions?
epicatechin, ECG, EGC, ECGC | potent antioxidants
29
Green tea interferes with which steps of carcinogenesis and metastasis? (4)
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
How does green tea prevent oncogene formation and tumour initiation? (4)
1. Inhibits metabolic activation of procarcinogens 2. Induces phase 2 conjugation for improved detox 3. Quenches free radicals 4. Modulates DND repair mechanisms
31
How does green tea inhibit tumour promotion? (3)
1. inhibits TNF-alpha release from neoplastic cells 2. Inhibits telomerase activity 3. Downregulates cyclin D1 and cyclin-dependent kinase
32
How does green tea inhibit tumour progression? (2)
1. Induces cell cycle arrest through inhibition of mitotic signalng 2. Inhibits angiogenesis by altering intracellular signaling and decreasing VEGF production
33
Green tea key studies
``` 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
Green tea dosage
5-10 cups daily or 1000-2000 mg catechins
35
Green tea adverse effects
>5 litres day may cause N/V, abdominal bloating and pain, dyspepsia, flatulence, diarrhea
36
Green tea interactions
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
Curcumin actions
Anti-inflam, antioxidant, hepatoprotective, antimicrobial, anticarcinogenic,
38
Curcumin mechanisms (6)
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
Curcumin key trials on cancer
8 g curcumin w/ gemcitabine-resistant pancreatic cancer increased survival time May slow progression of MGUs and SMM
40
Curcumin key trials on chemo/ radiation side effects
2 g TID reduced radiation-induced dermatitis in breast cancer reduced adverse effects in various cancers
41
Curcumin dosage
4-8 g
42
What substance increases absorption of curcumin?
Piperine
43
Curcumin adverse effects
Up to 12 g - diarrhea, yellow stool, headache, rash | Binds iron
44
Curcmin inhibits the cytotoxic effects of which agents?
Adriamycin, camtothecin, mechlorethamin (breast cancer in vitro), cyclophosphamide (breast cancer in mice )
45
Which agents are known to be safe to combine with curcumin?
Docetaxel (breast and colon), FOLFOX (colon)
46
Other curcumin cautions
interactions with P-glycoprotein substrates, cytochrome P450 enzymes Suppresses platelet agregation Some believe it's estrogenic
47
Curcumin CI
biliary duct obstruction, gallstones
48
How do medicinal mushrooms likely work?
Immunomodulatory effects - enhances innate imunity and tumor specific adaptive immunity Activate NK, T, B, and macrophage immune system responses
49
What are the immunomodulatory effects of medicinal mushrooms d/t?
beta-1-3,1-6-D-glucans
50
What is the scientific name for Coriulus/ Turkey Tail?
Trametes versicolor
51
What are the two proteoglycan constituents of coriulus?
polysaccharide-krestin (PSK) and polysaccharopeptide (PSP)
52
Coriolus mechanism
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
Coriolus key studies
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
Coriolus dose
3 d daily | Ideally, 1500 mg BID away from food
55
Coriolus max safe dose
9 g
56
Coriulus interactions
none
57
Reishi scientific name
Ganoderma lucidum
58
Reishi mechanism
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
Reishi key studies
Reishi + chemo/ radiation = better response, relatively improved QOL Improved host immune function indicators
60
AHCC comes from which mushrooms?
Several species of Basidiomycete, includine shittake (Lentinus)
61
AHCC key studies
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
AHCC dosage
3 g daily
63
AHCC a/e
Diarrhea and itching
64
AHCC interactions
Induces CYP 2D6, which can decrease drug activity (doxorubicin, ondansetron)
65
White Button Mushroom scientific name
Agaricus bisporus
66
Agaricus key studies
decrease PSA in biochemically recurrent prostate cancer | Inhibit aromatase activity
67
How are high quality mushrooms extracts made?
Using liquid fermentation - mycelium are grown in sterilized liquid nutrient media under stable temperature
68
What's the difference between high and low quality mushroom products?
Low quality are grown on rice and contain marginal beta glucan concentrations

Oncology (7 decks)

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