One might assume that medicinal plants have no place in oncology practice. And indeed, apart from the mistletoe therapy of anthroposophic medicine, there is no Western medicinal plant with an antitumor potential. However, numerous herbal applications can alleviate chemotherapy- or radiotherapy-related discomfort. In the following, some such applications are presented.
No serious scientist claims that one can treat or cure tumor diseases with herbal mixtures or herbal tinctures – apart from the (co-)treatments with mistletoe preparations promoted by anthroposophical circles.
However, if one considers the entire spectrum of oncology and takes into account all the possibilities of palliative and supportive medicine, then herbal medicines can certainly play a role in these areas that should not be underestimated. Especially as supportive measures for the prevention and treatment of adverse effects associated with oncological therapy, certain herbal medicines and other integrative measures are often best suited.
Society for Integrative Oncology
In the USA, where phytotherapy usually has a hard time, surprisingly a society for integrative oncology was founded: The Society for Integrative Oncology (SIO) (www.integrativeonc.org). Founded in 2003, this multidisciplinary and international society aims to bring together a wide range of professionals involved in the treatment, care and support of oncology patients. These include specialists in conventional oncology, but also physicians practicing complementary medicine, nutritionists, psychologists, etc. In intensive collaboration, the SIO has developed guidelines for holistic oncology, e.g. the guidelines published in 2009 with a focus on “botanicals” [1]. In the USA, for example, herbal medicines are referred to as “food additives” or “herbals” because herbal medicines cannot be registered as drugs there. Unfortunately, with regard to herbal preparations, these guidelines mainly refer to possible interactions with synthetic preparations and less to the benefits
in the treatment of therapy-related complaints, as shown below.
Mistletoe therapy
Mistletoe therapy, which is promoted by anthroposophical circles, will not be discussed in detail here, since it is not part of traditional phytotherapy, but is an anthroposophical type of treatment. There are extensive studies on the efficacy of mistletoe preparations. In the past, the majority of studies investigated survival time, frequency and/or duration of remissions, and more recently the quality of life of cancer patients treated with mistletoe preparations [2,3]. These studies show a significant improvement in quality of life.
Two types of mistletoe preparations are approved in Switzerland: Iscador® and Helixor®. Most studies have been conducted with the former.
Mucositis
Mucositis is a very common mucosal inflammation of the mouth and pharynx that occurs as a side effect of chemotherapy and radiotherapy and affects the gums, tongue, pharynx, larynx and/or esophagus, as appropriate. Mucositis manifests as redness, edema, atrophy, ulceration, and bleeding.
At the 21st Swiss Conference on Phytotherapy on November 23, 2006, phytotherapeutic options for the treatment of these complaints were presented in a paper [4]. While there are few controlled clinical trials documenting the efficacy of the applications presented in the following. According to the speaker, however, the use of phytotherapeutic extracts and tea preparations in prophylaxis and therapy of mucositis under antitumor treatment plays an essential role, even in otherwise only conventionally oriented oncological centers.
Sage (Salvia officinalis): Thanks to astringent, antiphlogistic, bactericidal, fungostatic and virostatic ingredients such as thujone, cineole, camphor, di- and triterpenes, flavonoids and caffeic acid derivatives of sage, corresponding preparations are suitable for the treatment of mucositis in the form of rinses, brushes or for gargling.
Chamomile (Matricaria recutica): The main ingredients of chamomile are essential oil, flavonoids and mucilage, which are also suitable for the treatment of lesions in the mouth and throat area thanks to their antiphlogistic, wound-healing, bacteriostatic and fungistatic activity.
Calendula (Calendula officinalis): Calendula tinctures contain triterpene glycosides, flavonoids, carotenoids, polysaccharides and essential oil. They have antimicrobial and antiphlogistic effects, promote wound healing and stimulate the immune system.
Witch hazel (Hamamelis virginiana): extracts from the bark and leaves have antiphlogistic and astringent effects and are therefore suitable for the treatment of mucositis.
Other astringents: There are a number of other medicinal plants with a pronounced astringent effect. These include bloodroot (Potentilla tormentilla), myrrh (Commiphora molmol), and ratanhia (Krameria triandra). There are corresponding commercial preparations as rinses or brushes.
Xerostomia
Another problem occurring as a result of radiation therapies in oncological patients is the impairment of salivary gland function. This leads to a very unpleasant dry mouth. Many patients find it difficult to speak and their sense of taste is impaired. Loss of appetite may also occur.
Bitter drugs, whose bitter ingredients stimulate the secretion of the salivary glands, can be used to treat this problem. There are commercial preparations in the form of drops containing corresponding medicinal plants such as centaury (Centaurium umbellatum), gentian (Gentiana lutea), wormwood (Artemisia absinthium) etc. Such medicinal plants can also be prescribed individually as tincture or mother tincture.
Hepatotoxicity
Some oncologics also have hepatotoxic potential. In 2010, a study appeared that investigated the effect of milk thistle (Silybum marianum) in children with acute lymphoblastic leukemia [5]. In this randomized, placebo-controlled, double-blind study, 50 children with acute lymphoblastic leukemia and chemotherapy-induced hepatotoxicity were administered either a milk thistle preparation or placebo. After 56 days of treatment, the verum group had significantly lower hepatotoxicity than the comparison group.
Non-Western Phytotherapy
In recent years, numerous reports on plants of non-Western phytotherapy have appeared. For example, one study showed that extracts from Garcinia mangostona, a tree that grows in the Malay Peninsula, have anti-cancer properties in vitro [6].
A study published in 2010 reported the efficacy of various medicinal plants of Kampo medicine native to Japan in the treatment of chemotherapy-related side effects [7].
In the same year, a study appeared showing that the Chinese medicinal plant Rhodiola algida had a beneficial effect on chemotherapy-induced mucositis in breast cancer patients [8]. This medicinal plant belongs to the same genus as Rhodiola rosea (rose root), which is used in Western phytotherapy against stress symptoms.
Summary
Apart from mistletoe preparations used in anthroposophic medicine, there are no Western medicinal plants with anticancer activity. However, numerous herbal preparations can alleviate tumor treatment-related discomfort. In particular, these include mucositis, xerostomia, and hepatotoxicity.
Literature:
- Deng CE, et al: Integrative oncology practice guidelines. Evidence-based clinical practice guidelines for integrative oncology: complementary therapies and botanicals. J Soc Integr Oncol 2009; 7(3): 85-120.
- Tröger W, et al: Additional Therapy with Mistletoe Product during Adjuvant Chemotherapy of Breast Cancer Patients Improves Quality of Life: An Open Randomized Clinical Pilot Trial. Evidence Based Complementary and Alternative Medicine 2014. doi: 10.1155/2014/430518.
- Tröger W, et al: Quality of life of patients with advanced pancreatic cancer under mistletoe therapy. Deutsches Ärzteblatt 2014; 111(29-30): 493-502.
- Rostock M: Phytotherapy in prevention and therapy of mucositis in tumor patients. Paper presented at the 21st Swiss Conference on Phytotherapy, Baden, 23.11.2006. Paper published in: phyotherapy 2007; 7(1): 26-29.
- Ladas EJ, et al: A randomized, controlled, double-blind, pilot study of milk thistle for the treatment of hepaotxicity in childhood acute lymphoblastic lekemia (ALL). Cancer 2010; 116(2): 506-513.
- Pan-In P, et al: Cellular trafficking and anticancer activity of Garcinia mangstona extract-ecapsulated polymeric nanoparticles. Int J Nanomedicine 2014; 9: 3677-3686.
- Ohnishi S, Takeda H: Herbal medicines for the treatment of cancer chemotherapy-induced side effects. Front Pharmacol 2015; 6: 14.
- Loo WT, et al: Rhodiola algida improves chemotherapy-induced oral mucositis in breast cancer patients. Expert Opin Investig Drugs 2010; 19(Suppl 1): 91-100.
HAUSARZT PRAXIS 2015; 10(7): 4-5
