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Traditional Chinese Medicine in the Prevention and Treatment of Cancer and Cancer Metastasis (Review)

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Traditional Chinese Medicine in the Prevention and Treatment of Cancer and Cancer Metastasis (Review) 1240 ONCOLOGY LETTERS 10: 1240-1250, 2015 Traditional Chinese medicine in the prevention and treatment of cancer and cancer metastasis (Review) LIN YE1-3, YONGNING JIA1,2,4, KE JI1-3, ANDREW J. SANDERS1-3, KAN XUE4, JIAFU JI4, MALCOLM D. MASON3 and WEN G. JIANG1-3 1Cardiff University-Peking University Cancer Institute; 2Metastasis and Angiogenesis Research Group; 3Institute of Cancer and Genetics, Cardiff University School of Medicine, Cardiff CF14 4XN, UK; 4Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Gastrointestinal Surgery, Peking University Cancer Hospital and Institute, Haidian, Beijing 100142, P.R. China Received June 16, 2014; Accepted February 25, 2015 DOI: 10.3892/ol.2015.3459 Abstract. Traditional Chinese medicine (TCM) has been a Contents major part of healthcare in China, and has extensively affected medicine and healthcare in surrounding countries over a long 1. Introduction period of time. In the fight against cancer, certain anticancer 2. Chinese herbal medicine in combined therapies for remedies using herbs or herbal formulas derived from TCM malignancies have been developed for the management of malignancies. 3. Molecular and cellular machinery of TCM in the Furthermore, there are clinical trials registered for the use treatment and prevention of cancer of herbal remedies in cancer management. Herbal medi- 4. Targeting angiogenesis in solid tumours cine has been used as part of combined therapies to reduce 5. Herbal therapy for precancerous disorders the side-effects of chemotherapy, including bone marrow 6. Perspectives suppression, nausea and vomiting. Herbal remedies have also been used as chemopreventive therapies to treat precancerous conditions in order to reduce the incidence of cancer in 1. Introduction high-risk populations. Emerging evidence has revealed that herbal remedies can regulate the proliferation, apoptosis, The use of complementary and alternative medicine (CAM) adhesion and migration of cancer cells. In addition to this has been widely accepted as a therapeutic approach for the direct effect upon cancer cells, a number of herbal remedies management of malignancies, particularly in the supportive have been identified to suppress angiogenesis and therefore and palliative care of cancer patients. In 2007, $33.9 million was reduce tumour growth. The inhibition of tumour growth may spent by adults in the USA on CAM (1). Furthermore, CAM is also be due to modifications of the host immune system by the commonly used by cancer patients; in fact, 25-50% of prostate herbal treatment. However, the precise mechanisms under- cancer patients have used at least one CAM modality (2). As a lying the therapeutic effects of herbal remedies remain poorly major part of CAM in Western countries, traditional Chinese understood and are yet to be fully elucidated. The present medicine (TCM) has also been used to treat malignancies. study aims to summarize the current literature and clinical In 2011, a series of correspondences concerning traditional trial results of herbal remedies for cancer treatment, with a Asian medicines were published, which created interest in particular focus on the recent findings and development of the investigating the potential use of traditional Asian medicines Yangzheng Xiaoji capsule. for cancer management, in particular, the study of relevant therapeutic approaches using current scientific research methods (3). Traditional medicines, including those practiced in China, Korea, Japan and other countries worldwide, may appear mystical and pseudoscientific due to a poor scientific understanding of their actions and a lack of convincing clinical Correspondence to: Dr Wen G. Jiang, Cardiff University-Peking evidence according to the standards of modern science and University Cancer Institute, Henry Wellcome Building, Cardiff University School of Medicine, Heath Park, Cardiff CF14 4XN, UK medicine. Success has been achieved in studies of traditional E-mail: [email protected] medicine, including artemisinin for malaria and arsenic trioxide for leukaemia (4,5). To date, the majority of traditional Key words: traditional Chinese medicine, therapy, cancer, remedies lack the standardisation and scientific evidence metastasis required to validate their effect, efficiency and application. As part of traditional Asian medicines, TCM has been used to prevent and treat a number of disorders, with documentary YE et al: TCM IN THE TREATMENT OF CANCER 1241 evidence, for two thousand years. Over the last few decades, To date, a number of herbs have been reported to be benefi- studies of TCM in cancer have focused on molecules extracted cial to cancer patients. These include single herbs, traditional and purified from anticancer herbs. Icariside II, purified from herbal formulations and Chinese medicine preparations. A the root of Epimedium koreanum Nakai, is able to induce number of single herbs have been individually adopted for the apoptosis of human acute myeloid leukemia U937 cells cancer treatment, including Radix Astragali (Huang Qi) through the STAT3 pathway (6). Artemisinin, a compound (16), ginseng (Ren Shen) (17), blister beetle (also known extracted from the Chinese medical herb, Qing Hao, has been as Mylabris; Ban Mao) (18), toad venom (Chan Su) (19), widely used in the treatment of malaria, and has also been garlic (Da Suan) (20) and turmeric (Jiang Huang) (21). Chinese involved in cancer treatment (7-10). Based upon the evidence traditional herbal formulations were usually developed by from clinical studies, investigations of certain herbal remedies ancestors of TCM, and were based on Chinese medicine have been further developed into clinical trials to examine theories, including yin and yang, the five elements and merid- their efficacy and safety in cancer management. However, data ians. A single formulation often has numerous components. At concerning the effect and mechanisms of TCM in the preven- present, the formulations adopted for cancer treatment always tion and treatment of malignancies, particularly anticancer contain certain common major components, which are the remedies comprising multiple herbs, remain limited. popular single herbs with anticancer activities. The Yangzheng Xiaoji (YZXJ) capsule, derived from Chinese medicine preparations are recently developed a TCM formula, has exhibited anticancer actions (11). In a herbal remedies that are prepared from either single herb or randomized double-blind lung cancer study, patients who traditional herbal formulations using modern advanced phar- received treatment with conventional chemotherapy combined maceutical technologies. There are a number of different types with YZXJ (n=304) exhibited significantly increased levels of of preparations, including injections, tablets, pills, capsules and complete and partial disease remission compared with those orally-administered liquids. Compared with traditional decoc- who received chemotherapy alone (n=103) (23.3 vs. 14%, tions, Chinese medicine preparations are safer, more effective respectively; P<0.01) (11). The patients who received YZXJ and easier to use. With the development of pharmacological also presented with decreased bone marrow suppression. research concerning herbal medicines, increasing numbers Previous studies have established that YZXJ is able to of effective ingredients have been successfully extracted directly inhibit the adhesion and migration of cancer cells. and their efficacy clarified, which has promoted the develop- In addition to its direct effect on cancer cells, it is also able ment of Chinese medicine preparations. Mylabris has been to suppress the angiogenic capacities of vascular endothelial identified to induce the apoptosis of cancer cells and promote cells, which may contribute to the inhibitory effect on in vivo functions of the immune system, but it is greatly restricted in tumour growth (12-14). its clinical application due to renal toxicity and bone marrow Although progress has been made in the research and suppression (22). Subsequent studies have demonstrated application of herbal remedies for the treatment of malig- that cantharidin is one of its effective ingredients and that a nancies, data from clinical trials are still required in order number of artificial analogues of cantharidin exhibit similar to understand the mechanisms that underlie the action of effects, but with lower toxicities (23,24). Increased knowledge these medicines and therefore guide their clinical application of herbal medicines will aid in the understanding of Chinese appropriately. formulations and preparations for the treatment of cancer. The present review summarises the data on single herbs and 2. Chinese herbal medicine in combined therapies for ma- Chinese medicine preparations that are widely adopted for the lignancies treatment of cancer. The present review describes the commonly used single At present, common treatments for cancer include surgery, herbs, Radix Astragali (Huang Qi), ginseng (Ren Shen), Myla- chemotherapy, radiotherapy, immunotherapy and targeted bris (Ban Mao) and toad venom (Chan Su), which according therapy. Surgery remains the first treatment choice for the to preclinical studies and clinical trials, have anticancer majority of early-stage solid tumours, whilst other treat- activities. Garlic (Da Suan) and turmeric (Jiang Huang) have ments and surveillance may be used in the management of demonstrated marked anticancer activities in preclinical and advanced-stage tumours, or as
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