Abstract
Long-term endocrine treatment which results in estrogen deprivation causes chronic stress associated with a series of uncomfortable symptoms leading not only to a decrease in quality of life but also to cancer recurrence, which may be mediated primarily through the enhanced expression of angiogenic factors, as well as a series of inflammatory microenvironmental changes that favor tumor progression. In this study, we designed a clinical trial and aimed to explore the effects of Sanhuang Decoction (SHD) treatment on chronic stress, inflammatory factors, and breast cancer recovery. A total of 90 patients with breast cancer who met the inclusion/exclusion criteria were randomly allocated to a treatment or control group. The treatment group received the standard endocrine treatment and the traditional Chinese medicine decoction known as SHD. The control group received the standard endocrine treatment only. The treatment period was 6 months. The modified Kupperman Menopausal Index, the self-rating anxiety scale, and the self-rating depression scale were evaluated once per month. The body microenvironment plasma indices related to chronic stress, such as oxidative and antioxidative stress markers, inflammatory factors, hemorheology, coagulation, lipid and D-dimer, immunologic functions, tumor biomarkers, and angiogenic factors of the vascular endothelial growth factor (VEGF) were measured before and after 6 months of treatment. After treatment for 5 months, the scores in the treatment group decreased to nearly normal levels and the control group showed no significant improvement. After treatment for 6 months, all indices related to the body microenvironment, as well as the tumor biomarkers and carcinoembryonic antigen, carbohydrate antigen 153, and angiogenic factor VEGF levels improved significantly to normal levels in the treatment group. Our primary research showed that treatment with SHD effectively improved the quality of life of breast cancer patients by facilitating a change in the body microenvironment that controlled tumor growth and prevented drug resistance.Clinical Trial RegistrationChinese Clinical Trial Registry, identifier ChiCTR-IIR-2000041413. Date of registration: 2017-06-07 (retrospective registration).
Highlights
Breast cancer is the most common cancer among Chinese women [1]
There were no statistically significant differences between the two groups in terms of age, clinical stage, modus operandi, types of endocrine treatment, the duration of treatment, and the drugs used for endocrine treatment (Table 1)
Our primary results showed that the patients in both groups experienced a moderate degree of menopausal symptoms with an average Kupperman Menopausal Index (KMI) score of approximately 33
Summary
Breast cancer is the most common cancer among Chinese women [1]. Breast cancer treatments have evolved over the last 40 years from profound and aggressive to conservative procedures that minimize tissue trauma and physical deformity. Studies have reported that chronic stress can alter immunological, neurochemical, and endocrine functions leading to cancer progression, which may be mediated primarily through the activation of the tumor cell phosphoinositide 3‐kinase (PI3K) signaling pathway This results in a markedly increased vascularization and an enhanced expression of the vascular endothelial growth factor (VEGF), matrix metalloproteinase (MMP)-2, and MMP-9 [5, 6]. Studies have suggested that while tumor cells adapted to the long-term reactive oxygen species (ROS)induced toxicity, this promoted acquired multidrug resistance in breast cancer cells through the PI3K/protein kinase B (PI3K/Akt) and NF-ĸB pathways regulated by the stress-related factors, NF-E2-related factor 2 (Nrf2), hypoxia-inducible factor 1, and protein kinase C [11] These results are derived from experimental research and have not yet been verified by clinical trials. In this study, we designed a clinical trial and aimed to explore the effects of SHD treatment on chronic stress, inflammatory factors, and breast cancer recovery
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