Yap Kevin Yi-Lwern, See Cheng Shang, Chan Alexandre
Department of Pharmacy, Faculty of Science, National University of Singapore, Block S4, 18 Science Drive 4, Singapore 117543.
Recent Pat Food Nutr Agric. 2010 Jan;2(1):12-55. doi: 10.2174/2212798411002010012.
Complementary and alternative medicines (CAMs), in particular herbal medicines, are commonly used by cancer patients in conjunction with chemotherapy treatment for their anticancer properties and supportive care. However, the effects of many of these herbs are not well-documented due to limited studies done on them. Severe herb-drug interactions (HDIs) have been recorded in some cases, and failure to recognize these harmful HDIs can lead to dire consequences in cancer patients. This study discusses clinically-relevant interactions between anticancer drugs (ACDs) and herbs classified into 7 categories: cancer treatment and prevention, immune-system-related, alopecia, nausea and vomiting, peripheral neuropathy and pain, inflammation, and fatigue. Some promising patents which contain these herbs and thus may manifest these interactions are also presented in this article. Pharmacokinetic interactions involved mainly induction or inhibition of the cytochrome P450 isozymes and p-glycoprotein, while pharmacodynamic interactions were related to increased risks of central nervous system-related effects, hepatotoxicity and bleeding, among others. Clinicians should be vigilant when treating cancer patients who take CAMs with concurrent chemotherapy since they face a high risk of HDIs. These HDIs can be minimized or avoided by selecting herb-drug pairs which are less likely to interact. Furthermore, close monitoring of pharmacological effects and plasma drug levels should be carried out to avoid toxicity and ensure adequate chemotherapeutic coverage in patients with cancer.
补充和替代医学（CAMs），尤其是草药，因其抗癌特性和支持性护理作用，常被癌症患者与化疗联合使用。然而，由于对其中许多草药的研究有限，它们的效果尚未得到充分记录。在某些情况下，已记录到严重的草药-药物相互作用（HDIs），而未能识别这些有害的HDIs可能会给癌症患者带来可怕的后果。本研究讨论了抗癌药物（ACDs）与分为7类的草药之间的临床相关相互作用：癌症治疗与预防、免疫系统相关、脱发、恶心与呕吐、周围神经病变与疼痛、炎症和疲劳。本文还介绍了一些含有这些草药因而可能表现出这些相互作用的有前景的专利。药代动力学相互作用主要涉及细胞色素P450同工酶和P-糖蛋白的诱导或抑制，而药效学相互作用则与中枢神经系统相关效应、肝毒性和出血等风险增加有关。在治疗同时服用CAMs和化疗药物的癌症患者时，临床医生应保持警惕，因为他们面临着较高的HDIs风险。通过选择不太可能相互作用的草药-药物组合，可以将这些HDIs降至最低或避免。此外，应密切监测药理作用和血浆药物水平，以避免毒性并确保癌症患者获得足够的化疗效果。
