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Department of Traditional Chinese Medicine, Medical College of Jinan University; 2Department of Oncology,
Clifford Hospital of Guangzhou University of Traditional Chinese Medicine, Guangzhou, Guangdong510632;
3
Clinical Institute, Jining Medical University, Jining, Shandong 272013; 4Department of Pancreatic Disease Center,
The First Affiliated Hospital of Jinan University, Guangzhou, Guangdong510632, P.R. China
Received August 18, 2015; Accepted September 25, 2015
DOI: 10.3892/br.2015.537
Abstract. The morbidity associated with cancer has rapidly
increased in recent years, and in the previous 5years has had
a tendency to be the leading cause of fatality compared with
cardiovascular disease. Therefore, effective measures are
required with an aim to reduce the incidence. Based on the
results of clinical investigation, a multidisciplinary treatment
strategy for cancer, which includes radiotherapy, chemotherapy, surgery, targeted therapy and immunotherapy, are
prominently used in clinical practice. However, the therapies
are insufficient due to multidrug resistance, adverse effects
and the presence of the root of the cancer. Therefore, there is
a necessity to develop more effective or adjunctive therapies
for cancer prevention and treatment. Cancer is now widely
recognized as a systemic humoral disease. Similarly, the function of herbal drugs is to modulate the whole body system
in a more holistic way. Recently, herbal drugs have been
applied to one of the efficient approaches for cancer therapy.
Furthermore, there is evidence that various herbal medicines
have been proven to be useful and effective in sensitizing the
conventional agents against the various factors at the cellular
and molecular levels that are associated with the occurrence of
cancer and in prolonging survival time, alleviating side effects
of chemotherapy and radiotherapy and improving the quality
of life in cancer patients.
Contributed equally
Contents
1. Introduction
2. Inducing cellular apoptosis
3. Reversing multidrug resistance
4. Comprehensive efficacy on angiogenesis, cellular signaling
pathway and metastasis
5. Regulating the immunomodulatory activities
6. Enhancing the efficacy, reducing toxicity and improving
the quality of life for patients
7. Conclusion and future perspectives
1. Introduction
The database from the American Cancer Society(ACS)
provides a summary of the current ACS cancer screening rates.
Aside from skin cancer, the major incidence of cancer in 2015
was reported as cancer of the female breast, prostate cancers in
males, and colorectal and lung cancer(1), and according to the
study of Brayetal(2) reported in Lancet Oncology, the incidence of the total cancer cases will increase from 12.7million
new cases in2008 to 22.2million by2030. Therefore, cancer
specialists have determined that cancer is a lifethreatening
disease for future generations(3). Therefore, it is necessary
to implement national cancer control plans to reduce the
burden of cancer risk factors. Increasing attention has been
paid to improve the palliative care and pain relief available
to patients. Even though the skills of surgery, radiotherapy
and chemotherapy, targeted therapy and immunotherapy have
significantly improved, an increasing number of patients are
selecting naturopathic therapy with traditional Chinese medicine (TCM), as they are considered to be multicomponents
and multitarget agents exerting their therapeutic function in a
more holistic way to the whole body system via restoration of
the normal balance and flow in the body, which is believed to
strengthen and enhance the endogenous resistance of the body
to disease and individualization of therapy. In addition, the
approval of three new herbal medicinederived drugs (ixabepilone, trabectedin and temsirolimus)(4) in2007 instigated the
consideration of herbal medicines as a source for innovative
Tumor name
Efficacy according to
bio-molecular levels
Active components
Tumor name
Efficacy according to
bio-molecular levels
Preclinical or clinical evidence of anticancer activity
Ethanol extract of
Colon cancer cells, CRC
Induced cell apoptosis,
Induced cell apoptosis, inhibited angiogenesis invivo, reduced tumor size without
Scutellaria barbata
mouse xenograft model
inhibited angiogenesis and
affecting body weight, suppressed the expression of key mediators of the pathway
a signaling pathway
in tumor tissues, inhibited the expression of the target gene of the SHH signaling
pathway, vascular endothelial growth A (VEGF-A)
Xiaotansanjie decoction
GCSCS
Inhibited angiogenesis and
Regulated the expression of Notch-1, Hes1, VEGF and ki-67, inhibited the cell
tumor growth, induced cell
viability invivo, inhibited the expression of i Notch-1 and Hes1 to inhibit tumor
apoptosis growth
Baicalin
MDA-MB -231 cells
Inhibited metastasis and a
Inhibited cell migration and invasion, suppressed tumor growth and the pulmonary
signaling pathway
metastasis via blocking the p38 mitogen-activated protein kinase (MAPK) activity
and activated the inhibitor of p38 MAPK to decrease the expression of matrix
metalloproteinase (MMP)-2, MMP-9, uPA and uPAR through the P38-MAPK
signaling pathway
Pien Tze Huang
Mouse model of
Inhibited tumor and
Reduced the expression of angiogenic factors, including inducible nitric oxide
colorectal cancer
angiogenesis, suppressed
synthase (iNOS), endothelial NOS, VEGF-A, basic fibroblast growth factor (bFGF),
signaling pathways
as well as their specific receptors, VEGFR2 and bFGFR, to inhibit tumor
angiogenesis via suppression of multiple signaling pathways, such as STAT3, AKT
and MAPKs
Ganoderic acid
Breast cancer cells
Induced cell apoptosis,
Suppressed cell growth, tumor angiogenesis and invasion, stimulated Me (GA-Me)
inhibited tumor angiogenesis
the production of tumor necrosis factor- (TNF-), downregulated the expression of
and metastasis to suppress a
various nuclear factor-B (NF-B) regulated genes [C-myc, cyclinD, Bcl-2, MMP-9,
signaling pathway
VEGF, interleukin (IL)-6 and IL-8] to modulate the NF-B signaling pathway
TPA and saikosaponin
HepG2 cell
Suppressed signaling pathway Induced the phosphorylation of ERK, JNK and c-jun by activating the downstream
to inhibit angiogenesis
transcriptional factors of the MAPK cascade (ATF2, c-jun, jun-B and c-fos),
decreased the efficacy of P15(INK4b)/p16(INK4a) RNAs, c-fos RNA protein and
AP-1-related DNAbinding activity
Nobiletin
Human gastric
Inhibited angiogenesis by
Inhibited FAK and Pi3K/Akt activation to downregulate the enzyme activities,
adenocarcinoma
suppressing signaling pathways protein expression and messenger RNA levels of MMP-2 and MMP-9, Ras, C-Raf,
AGS cells,
to inhibit tumor metastasis
Rac-1, Cdc42 and RhoA, increased the protein level of RhodB, decreased the
phosphorylation and degradation of I and NF- to inhibit the cell adhesion and
invasion
Active components
Table I. Continued.
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NIE et al: MODERN APPLICATION OF TCM IN ONCOLOGY
Tumor name
Efficacy according to
bio-molecular levels
Preclinical or clinical evidence of anticancer activity
Astragalus polysaccharides
S180 sarcoma-bearing mice Enhanced immunomodulatory Increased the IFN-, FasL and GrB mRNA levels, improved the activity of intestinal
activities intraepithelial T cytotoxicity of T cells and TNF- and IFN- levels
Wogonin
SGC-7901 and MFC cells
Enhanced immunomodulatory Exerted cytotoxicity to induce apoptosis of cancer cells, direct or indirect with DC,
activities
promoted the recruitment of DC, T and NK cells into tumor tissues to invert the
expression levels of VEGF, B7H1 and RAE-1, dephosphorylate STAT3 to inhibit
its activation on tyrosine 705 to decrease the expression of B7H1 and MHC classI
chain-related proteinA and enhance calreticulin on the cell membrane
Mistletoe lectin-55
Colon cancer cell and
Enhanced immunomodulatory Enhanced Agspecific activation and proliferation of CD4+ and CD8+ T cells and
colon cancer-bearing
activities
increased the number of tumor Agspecific CD8+ T cells with increasing production
BALB/C mice
of IFN-, increased activation of NK and T cells to delay colon cancer
development
Alocasia cucullata
Mouse tumor models
Enhanced immunomodulatory Enhanced the key cytokines invivo, such as IL-2, IFN- and TNF-. Invitro,
and mammalian cancer cells activities
activated the differentiation of THP-1 into macrophage-like cells with specific
macrophage surface markers, such as CD11b and CD14, and increased the induction
of TNF- and IL-1
Ganoderma lucidum
Cancer patients in a
Enhanced immunomodulatory Increased the mean concentration of plasma IL-2, IL-6 and IFN- and decreased
(lucid ganoderma)
clinical trial, in mouse
activities, induced cell
the levels of IL-1 and TNF- in clinical trials, increased CD56+ (NK cells) and
models invivo and
apoptosis, antimetastasis and
CD3+ (T lymphocyte), CD4+ (T helper cells) and CD8+ (T suppressor cells) invivo
in cells invitro antiangiogenesis and invitro, cell cycle arrest, induced cell apoptosis, antiinvasion, antimigration,
immunomodulation and antiangiogenesis
LQ (a mixture of
Lung cancer in
Induced cell apoptosis,
Inhibited tumor size and weight, exhibited antiangiogenic activity and prolonged
Chinese medicinal herbs,
mouse models
antiangiogenesis,
the survival of tumor-bearing mice compared with DOX, inhibited lung cancer
comprising Sinapisalba,
antimetastasis, enhanced
metastasis without weight loss and organ toxicity compared to CTX and DOX.
Atractylodes macrocephala,
efficacy and reduced toxicity
Invitro, induced cell death on cancer cell lines compared to normal cell lines
Coix lacryma-jobi and
Polyporus adusta)
Astragalus, turmeric,
Clinical trials on
Enhanced the immune
Suppressed tumor progression, increased the sensitivity of chemo- and
ginseng, Huachensu
patients and H22 cells
function, enhanced efficacy,
ratiotherapeutic treatment accompanied by lessening the damage and enhanced
injection and
reduced toxicity side effects
the immune system function from the preclinical and clinical studies, reduced
Kanglaite injiection
and improved life quality
cancer-related fatigue pain and the symptoms of cachexia, as well as resistance to
respiratory tract infections and alleviation of gastrointestinal side effects (diarrhea,
nausea and vomiting) and protection of the liver function, decreased the expression
of survivin, increased the expression of caspase-9 in H22 cells
Active components
Table I. Continued.
Tumor name
Efficacy according to
bio-molecular levels
Curcumin
MCF-7 cells, animal cancer, Induced cell apoptosis, tumor
models, colorectal
metastasis, enhanced efficacy,
cancer cells (CRC)
improved life quality
Scutellaria baicalensis and
Lewis lung carcinoma (LLC) Enhanced immunity, reduced
Qing-Shu-Yi-Qi-Tang
invivo and invitro
toxicity
Chinese herbal medicine
Advanced non-small cell
Enhanced efficacy, reduced
(CHM) (Radix Astragalus,
lung cancer patients
toxicity, improved life quality
Radix Adenophorae,
Radix Ophiopogonis,
Radix Glycyrrhizae Poria
and Oldenlandia diffusa)
Liu-Jun-Zi-Tang, PHY906,
Patients following surgery
Enhanced efficacy, reduced
coumarin and aescine, ginseng, and with chemo- or
toxicity,
Huangqi, BanZhiLian,
radiotherapy, improved life
TJ-48, Huachansu, Shenqi,
quality
fuzheng and Kanglaite
injections
Active components
Table I. Continued.
8
NIE et al: MODERN APPLICATION OF TCM IN ONCOLOGY
10
11
12
Figure 1. Association of the anticancer mode of action with TCM in the tumor microenvironment. TCM anticancer activity involves targeting various steps
(cell proliferation, angiogenesis, cell signaling pathways, invasion, metastasis and multidrug resistance) to inhibit tumor development, reduce the toxicity of
other therapies to tumors in the microenvironments, and accordingly, to improve the quality of life for patients. TCM, traditional Chinese medicine; MRP,multidrug resistance protein; VEGF, vascular endothelial growth factor; PDGF, plateletderived growth factor; Pgp, Pglycoprotein.
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