Chinese Herbal Medicines Facilitate the Control of Chemotherapy-Induced Side Effects in Colorectal Cancer: Progress and Perspective.

Dongmei Chen,Weihong Cong,Jun Zhao

doi:10.3389/fphar.2018.01442

Abstract

Side effects, including nausea, vomiting, mucositis, peripheral neuropathy, and diarrhea, have been frequently reported in colorectal cancer (CRC) patients undergoing chemotherapy. Chinese Herbal Medicines (CHMs) display distinct clinical outcomes, as a result, they have been increasingly used as an adjuvant therapy to manage chemotherapy-induced side effects. In this review, we aim to intensively explore the molecular mechanisms of CHMs, underline the significance of CHMs in mitigating the side effects induced by chemotherapy, and examine the necessary studies required to understand the role of CHMs in alleviating chemotherapy-induced side effects. Specifically, ginger, Astragali Radix, and Liujunzi Decoction have been verified to ameliorate nausea and vomiting. Banxia Xiexin Decoction and Huangqin Decoction have been confirmed to be beneficial to mucositis and delayed-onset of diarrhea. Moreover, Niuche Shenqi Wan, Guilong Tongluo Decoction, Huangqi Guizhi Wuwu Decoction, and tumeric have been found to display potential therapeutic effects for preventing the genesis and development of peripheral neurotoxicity. These findings have further emphasized the pivotal role of CHMs in improving the outcomes of chemotherapy-induced side effects in CRC. Nonetheless, more molecular evidence is required to comprehensively understand and more appropriately apply CHMs in routine clinical practice for CRC.

Highlights

Colorectal cancer (CRC) is one of the most common malignancies, with incidence ranking the third among males and females worldwide
Experimental results have indicated that the aqueous extract of CS can lead to weight gain in mice, alleviating diarrhea and hemafecia, maintaining the intestinal length, reducing villus shortening, and inhibiting apoptosis and inflammation in the small intestine (Liu et al, 2013b). These findings demonstrate that CS exerts certain protective effect on chemotherapy-caused intestinal mucositis, which may be attributed to down-regulated apoptosis and inflammation
Current evidence from preclinical studies continually supports the notion that Chinese Herbal Medicines (CHMs) are effective in preventing or alleviating chemotherapy-induced side effects

Summary

Introduction

Colorectal cancer (CRC) is one of the most common malignancies, with incidence ranking the third among males and females worldwide. Chemotherapy is effective against cancer, yet it is associated with various side effects, including nausea, vomiting, diarrhea, oral mucositis, and neurotoxicity, which have thereby restricted its clinical application, lowered the quality of life of patients, and resulted in dose reductions, dose delays and even termination of chemotherapy (Wyatt et al, 2015). Despite the advancement in various treatment strategies in managing chemotherapy-induced side effects, such as 5HT3 receptor antagonist and dexamethasone for nausea and vomiting, calcium gluconate, magnesium sulfate and glutathione for attenuating peripheral neurotoxicity, and loperamide for irinotecan-induced diarrhea, these can hardly satisfy the requirements of patients undergoing chemotherapy (Mustian et al, 2011). The development of an alternative treatment to manage these side effects is required

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