Cancer Flashcards
Active component of coenzyme Q10
Coenzyme Q10 is the active component
Medicinal uses of coenzyme Q10
- Cardiac (CHF, angina, HTN)
- Neural (bipolar disorder, Parkinson’s, muscular dystrophy)
- Immune (breast cancer, chemotherapy-related fatigue)
- Other (diabetes, Lyme disease, aging skin)
MOA of coenzyme Q10
- Antioxidant and immunostimulatory activity
- May protect against doxorubicin cardiotoxicity, possibly through scavenging of free radicals
Safety of coenzyme Q10
- Likely safe when used orally and appropriately
- Possibly safe in children
- Possibly safe in pregnancy
- Insufficient evidence in lactation, so avoid use
Efficacy of coenzyme Q10
Insufficient evidence in terms of use for cancer
Drug interactions w/ CoQ10
- Alkylating agents
- Antihypertensives
- Warfarin
- Statins
Contraindications for CoQ10 use
- Hypo/hypertension
- Chemotherapy
Should CoQ10 be recommended for clinical use?
Not recommended for cancer prevention of adjunct therapy
What is turmeric?
Spice derived from root of turmeric plant, member of ginger family
Active component of turmeric
Curcumin
Medicinal uses of turmeric
- Arthritis
- Crohn’s disease and ulcerative colitis
- Liver and gall bladder conditions
- Colorectal and prostate cancer
MOA of turmeric
Chemopreventive and growth inhibitory effects thought to occur from effect on gene upregulation, which can cause induction of apoptosis in cancer cells
Safety of turmeric
- Likely safe
- Many studies have shown that it is generally well tolerated, other than GI side effects (N/V, diarrhea, dyspepsia)
Efficacy of turmeric
- Possibly ineffective for reduction of radiation dermatitis
- Thought to be “ideal chemopreventative agent w/ low toxicity, affordability, and easy accessibility” so high risk px may benefit from it
Drug interactions w/ turmeric
- P-gP inhibition
- Conflicting evidence of whether is inhibitor or inducer of CYP 1A1 and 1A2
- Antiplatelets (increase risk of bleeding)
- Anti-diabetics (increase risk of hypoglycemia)
Contraindications of turmeric
- GERD or gastric ulcer
- Gallstones or bile duct obstruction
- Pregnancy
Should turmeric be recommended for clinical use?
- Can be used as a chemopreventative and tx option b/c of potential benefits and minimal risks
- Shouldn’t replace conventional cancer therapies
What is shark cartilage?
Extracted cartilage from freshly caught sharks in Pacific Ocean
Active component of shark cartilage
Extracted cartilage which is then processed into gelatin capsules
Medicinal uses of shark cartilage
Prevention/ adjunctive tx/ mono-therapeutic tx for cancer
MOA of shark cartilage
- Sharks rarely get cancer b/c are cartilaginous so are avascular and contain vascularization inhibitors
- Inhibitors of vascularization impede angiogenesis (thought to be effective against tumour cells in humans) and believed that shark cartilage induces apoptosis in tumour cells
Safety of shark cartilage
- Possibly safe when used orally and appropriately
- Safety demonstrated up to 24 weeks
- Concern w/ teratogenicity in long-term use
Adverse effects of shark cartilage
- Mild to moderate GI distress
- Taste alteration
Efficacy of shark cartilage
- Likely ineffective
- Randomized, double-blind, placebo-controlled study demonstrated no improvement
Drug interactions w/ shark cartilage
- Immunosuppressants
- Calcium
- Thiazide diuretics (risk of hypercalcemia)
- Fruit juice
Contraindications for shark cartilage use
- Caution in px w/ coronary artery disease and PAD
- Caution in px w/ renal disease, arrhythmias, or cancer
- Pregnancy and lactation
Should shark cartilage be recommended for clinical use?
Not recommended for prevention, tx, or adjunctive therapy b/c no clinical evidence
What is another name for Panax ginseng?
Asian ginseng
Medicinal uses of panax ginseng
- Cancer
- Cancer-related fatigue
- Alzheimer’s disease
- Immune stimulation
Active components of panax ginseng
Ginsenosides main component for cancer uses
MOA of panax ginseng
- Decrease production of tumor necrosis factor
- Diminish DNA strand breakage
- Inhibit formation of induced skin tumors
Contraindications for panax ginseng use
- Hemorrhagic or thrombotic disorders
- Diabetes, autoimmune disorders and cardiac conditions
Drug interactions w/ panax ginseng
- Anticoagulants
- Is a CYP 2D6 inhibitor, 3A4 inducer, and interacts w/ 2C19; px on any anti-cancer drugs metabolized by these enzymes should avoid use
Efficacy of panax ginseng
Insufficient evidence likely due to lack of standardization and in vivo studies on Ginseng
Safety of panax ginseng
- Safe when used orally for less than 6 months
- Unsafe in children, pregnancy, and long term oral use
Should panax ginseng be recommended for clinical use?
- Lack of clinical evidence, so not recommended over traditional remedies
- No in vivo studies proving efficacy
- Can take w/ caution as long as no drug interactions or contraindications
What is red clover?
Legume w/ phytoestrogens (plant-based compounds structurally similar to estradiol) that are capable of binding to estrogen receptors as agonists or antagonists
Active component of red clover
Isoflavones
Medicinal uses of red clover
Prevention of breast and endometrial cancer
Safety of red clover
- Likely safe when used orally in amounts commonly found in foods
- Possibly safe when used orally or topically in medicinal amounts
- Pregnancy and lactation - likely safe when used in amounts commonly used in foods; likely unsafe when used orally in medicinal amounts b/c of estrogenic activity
Adverse effects of red clover
- Nausea
- Headache
- Myalgia, weight gain
- Increased duration of menstrual cycles
Efficacy of red clover
Insufficient evidence
Drug interactions w/ red clover
- Anticoagulants/ antiplatelets
- Contraceptives/ estrogens
- Tamoxifen
Contraindications for red clover use
- Hormone sensitive cancers and conditions
- Coagulation disorders
MOA of red clover
- Estrogen receptor agonist and antagonist
- Metabolites have high affinity for beta-estrogen receptors
- Anti-neoplastic effects may be attributed to effects on cell cycle and apoptosis
Should red clover be recommended for clinical use?
- Don’t recommend
- Very little reliable evidence to prevent endometrial and breast cancer
- Not enough evidence to determine a recommended dose
What is mistletoe?
Common name for many species of hemiparasitic plants that grow on pine, oak, and variety of other trees
Active components of mistletoe
Lectins and viscotoxins which are proteins shown to have cytotoxic and immunomodulatory actions
Medicinal uses of mistletoe
Injections of mistletoe extract used to treat cancer
MOA of mistletoe
- Definite pathway has yet to be identified
- Proposed mechanisms include direct cytotoxic action or immunomodulation (enhancing natural killer cell-mediated tumor cell lysis; downregulating key genes involved in tumor progression, malignancy, and cell migration and invasion)
Safety of mistletoe
Mistletoe and its berries are considered toxic as a whole, as are its active ingredients
Effects of mistletoe toxicity
- Gastroenteritis
- Hallucinations
- Seizures
- Anaphylaxis
Efficacy of mistletoe
- Evidence to support use of mistletoe as cancer tx is weak
- Some evidence suggests mistletoe may be used as adjunct to breast cancer therapy, but more research needed
Drug interactions w/ mistletoe
- No well documented interactions
- Caution w/ immunosuppressants, hepatotoxic drugs, antihypertensives
Contraindications for mistletoe use
Pregnancy and lactation
Should mistletoe be recommended for clinical use?
- Not recommended as single entity for cancer tx b/c low level of evidence
- May be used as adjunct to conventional cancer tx as long as consult medical professional and use commercially licensed products
What is melatonin?
- Hormone produced in pineal gland of brain from amino acid tryptophan
- Synthesis and release stimulated by darkness and suppressed by light
Active component of melatonin
Melatonin
Medicinal uses of melatonin
- Jet lag, insomnia, shift-work disorder
- Breast, lung, prostate, brain, head, neck, and GI cancer
MOA of melatonin
- Increases binding of GABA to its receptor
- Responsible for regulation of the body’s circadian rhythm, endocrine secretions, and sleep patterns
- For cancer, appears to protect against formation of tumours, by inhibiting proliferation and causing apoptosis in cancer cells
Safety of melatonin
- Likely safe when used short term or as a single dose
- Possibly safe when used long term
Efficacy of melatonin
- Possibly effective for solid tumours
- Some evidence suggests that taking combined high dose melatonin w/ conventional chemotherapy or IL-2 may improve tumour regression rate
- Also seems to help in decreasing chemotherapy toxicities
- Possibly effective in improving thrombocytopenia associated w/ cancer, cancer tx or other disorders from chemotherapy or IL-2
Common adverse effects of melatonin
- Overall well tolerated
- Headache, dizziness, drowsiness
- Nausea
Drug interactions w/ melatonin
- Anticoagulant/antiplatelets
- Anticonvulsants, antihypertensives
- Antidiabetic agents
- Immunosuppressants
- Contraceptives
- For all these drugs, monitor combination for possible adverse effects
Contraindications for melatonin use
- Autoimmune disease
- Lactose intolerance
- Renal impairment
Should melatonin be recommended for clinical use?
- Can be used as add-on therapy for cancer as long as no contraindications or drug interactions
- Possibly effective in solid tumours and reducing chemo toxicities
- Likely safe
What is laetrile?
Purified form of amygdalin, which is found in pits of many fruits
Active component of laetrile
R-amygdalin
Medicinal uses of laetrile
Reduce incidence of colon, lung, prostate, and rectal cancer
MOA of laetrile
- Amygdalin decomposes into hydrocyanic acid (cyanide), which is though to induce apoptosis of cancer cells, inhibit proliferation of cancer cells, and inhibit expression of cancer cell genes
Safety of laetrile
Likely unsafe when taken orally or IV since apricot kernel is source of cyanide
Efficacy of laetrile
Possibly ineffective for cancer by Natural Medicines Database
Drug interactions w/ laetrile
High dose vitamin C (increases risk of cyanide poisoning)
Contraindications for laetrile use
- Pregnancy and lactation (theoretical risk of teratogenesis)
- Allergy to almonds or fruit pits
- Vegetarians w/ B12 deficiency (increased risk of cyanide poisoning)
How has laetrile been studied?
Mainly studied alone as alternative tx to cancer, or as adjunctive therapy w/ other non-conventional tx
Should laetrile be recommended for clinical use?
- Don’t recommend
- No anti-cancer activity in human clinical trials
- Product is banned by the FDA
- No sound data and risk of cyanide poisoning
Safety of garlic
- Likely safe if used orally and appropriately; and in pregnancy when used in amounts commonly found in food
- Possibly safe if used topically (may cause severe skin infection); and in children
- Possibly unsafe if using raw garlic topically; and in pregnancy and lactation when used orally in medicinal amounts
Common adverse effects of garlic
- Malodorous breath/ body odour
- N/V
- Flatulence
- Increased risk of bleeding w/ oral garlic
Efficacy of garlic
- Inconsistent findings, but possibly effective in decreasing risk of developing prostate cancer in 50% of Chinese men
- Possibly ineffective in reducing risk of developing breast and lung cancer
Drug interactions w/ garlic
- Isoniazid
- Moderate interaction = anticoagulants, antidiabetics, antihypertensives, protease inhibitors, and CYP 3A4 substrates
Contraindications to garlic use
- Bleeding disorders
- Surgery (d/c 1-2 weeks prior to surgery)
MOA of garlic
- Stimulate T-cell proliferation
- Restore suppressed antibody responses
- Radical scavenging activity
- Induced apoptosis in human leukemia cells by ajoene
Medicinal uses of garlic
- Prevention of prostate, colorectal, gastric, and esophageal cancer
- Adjunctive therapy to chemo or radiation
Should garlic be recommended for clinical use?
- Not recommended
- Most studies done on prevention of cancer
- Don’t use in place of conventional chemotherapy and doesn’t improve QOL through management of side effects
What is the difference between essiac and sorrel?
- Essiac = NHP made up of 4 botanicals (burdock root, sheep sorrel, slippery elm, rhubarb)
- Sorrel = anticancer agent in essiac (active component)
Medicinal uses of essiac
Tx of cancer
MOA of essiac
In vitro research shows high concentrations of essiac have inhibitory effects on different human cancer cell lines
Administration of sorrel
Essiac commonly used orally as herbal tea, but also available as capsules, powder, and liquid extract
Safety of sorrel
- Possibly safe when used orally in Essiac
- Possibly unsafe when used orally in large amounts (possibility of oxalate poisoning)
- Possibly unsafe in children, pregnancy, and lactation
Efficacy of sorrel
Insufficient evidence for breast cancer
Drug interactions w/ sorrel
- No known drug interactions w/ sorrel
- Decreases absorption of calcium, iron, and zinc
Contraindications for essiac use
Children, pregnancy, and lactation
Should essiac be recommended for clinical use?
- Not recommended for treating cancer
- Considered possibly safe but insufficient evidence to rate efficacy
What is astragalus?
Genus of flowers first used in medicine in TCM
Active components of astragalus
- Efficacy due to variety of polysaccharides and saponins present
- No single chemical responsible for effectiveness
Medicinal uses of astragalus
- Chemotherapy toxicity
- Chemotherapy-related fatigue
- Prevention of chemo-related immune suppression
- Used in addition to conventional chemotherapy to stimulate immune cells
MOA of astragalus
- Boosts immune system by promoting killer T cells
- Increases antioxidant levels in body
- Anti-inflammatory effects by lowering TH2 hormones, which can reduce rate of tumour growth
Safety of astragalus
- Possibly safe
- Caution should be used in consumption of different species besides membranaceus or mongholicus
Efficacy of astragalus
- Insufficient evidence for chemotherapy toxicity and chemo-related fatigue
- Possibly effective in stimulating immune system and mitigating adverse effects related to chemo
Drug interactions w/ astragalus
- Cyclophosphamide
- Immunosuppressants
- Lithium
Contraindications for astragalus use
None identified yet
Should astragalus be recommended for clinical use?
- Potentially promising adjunct to chemotherapy to increase tolerability
- Should be considered if no major interactions
