title: Safety of herbal medicine use during chemotherapy in patients with ovarian cancer: a "bedside-to-bench" approach.
abstract: In this study, we explored herbal supplements used by patients during chemotherapy and test for herb-drug interactions and response of cancer cells to treatment. Patients with gynecological cancer referred to a complementary and integrative medicine (CIM) service were asked about their use of herbal medicine during chemotherapy. The leading five clinically relevant herbs selected for cytotoxicity analysis included the following: wheatgrass (Triticum aestivum), European mistletoe (Viscum album), ginger (Zingiber officinale), Ephedra (Ephedra campylopoda), and Oriental mistletoe (Viscum cruciatum). Cytotoxicity was examined using XTT assays in cisplatin-sensitive and resistant ovarian cancer cell lines (A2780, A2780CisR), and non-cancer kidney cells (HEK-293). The effect of the selected herbs on carboplatin and paclitaxel cytotoxicity was tested as well. Pro-apoptotic effects were tested using Poly(ADP-ribose) polymerase (PARP) cleavage. Of 98 patients referred to the CIM service, 42 (42.9%) reported using/intending to use herbal products during chemotherapy. European mistletoe and ginger exhibited significant anti-cancer activity in cisplatin-sensitive and resistant ovarian cells. Wheatgrass and ephedra reduced cytotoxicity of carboplatin on cisplatin-sensitive ovarian cancer cells, while ginger, European and Oriental mistletoe increased chemosensitivity in both cancer cell lines. Wheatgrass, European mistletoe, and ginger increased sensitivity to cisplatin-resistant cells treated with carboplatin and paclitaxel. No effect was observed with the addition of any of the herbs on non-cancerous embryonic kidney cells (HEK-293). Herbal medicine use by patients with ovarian cancer may influence anti-cancer activity of chemotherapy. Integrative physicians can provide "bedside-to-bench" guidance on the safety of these products.
authors.affiliation: Integrative Oncology Program, Oncology Service, Lin Medical Center, Clalit Health Services, 35 Rothschild St., Haifa and Western Galilee District, Israel. eranben@netvision.net.il.|Complementary and Traditional Medicine Unit, Department of Family Medicine, Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel. eranben@netvision.net.il.
authors.forename: Eran
authors.initials: E
authors.lastname: Ben-Arye
authors.affiliation: Gynecological Oncology Unit, Department of Obstetrics and Gynecology, Gynecologic Oncology Service, Carmel Medical Center, Haifa, Israel.
authors.forename: Ofer
authors.initials: O
authors.lastname: Lavie
authors.affiliation: Integrative Oncology Program, Oncology Service, Lin Medical Center, Clalit Health Services, 35 Rothschild St., Haifa and Western Galilee District, Israel.|Tal Center for Integrative Oncology, Institute of Oncology, Sheba Medical Center, Tel Hashomer, Israel.
authors.forename: Noah
authors.initials: N
authors.lastname: Samuels
authors.affiliation: Cancer Drug Discovery Program, Galilee Technology Center (Migal), Kiryat Shmona, Israel.
authors.forename: Hazem
authors.initials: H
authors.lastname: Khamaisie
authors.affiliation: Departments of Internal Medicine and Integrative Surgery Service, Bnai Zion Hospital, Haifa, Israel.
authors.forename: Elad
authors.initials: E
authors.lastname: Schiff
authors.affiliation: Integrative Oncology Program, Oncology Service, Lin Medical Center, Clalit Health Services, 35 Rothschild St., Haifa and Western Galilee District, Israel.
authors.forename: Orit Gressel
authors.initials: OG
authors.lastname: Raz
authors.affiliation: Cancer Drug Discovery Program, Galilee Technology Center (Migal), Kiryat Shmona, Israel.|Nutritional Sciences Department, Tel Hai College, Kiryat Shmona, Israel.
authors.forename: Jamal
authors.initials: J
authors.lastname: Mahajna
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage* / Q000494:pharmacology; D016190:Carboplatin / Q000008:administration & dosage / Q000494:pharmacology; D045744:Cell Line, Tumor; D004354:Drug Screening Assays, Antitumor; D016889:Endometrial Neoplasms / Q000188:drug therapy; D005260:Female; D057809:HEK293 Cells; D041743:Herb-Drug Interactions; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy*; D017239:Paclitaxel / Q000008:administration & dosage / Q000494:pharmacology; D008517:Phytotherapy / Q000009:adverse effects / Q000706:statistics & numerical data; D028321:Plant Preparations / Q000008:administration & dosage* / Q000009:adverse effects* / Q000494:pharmacology; D002583:Uterine Cervical Neoplasms / Q000188:drug therapy
chemical_list: D028321:Plant Preparations; D016190:Carboplatin; D017239:Paclitaxel
keywords: Drug-herb interaction; Gynecologic oncology; Integrative medicine; Safety