Review

Authors: E Kaegi

Physicians and patients have been frustrated by the lack of reliable information on unconventional therapies. To help fill this gap in the area of breast cancer therapy, the Canadian Breast Cancer Research Initiative formed a task force to advise it on how best to promote research into unconventional therapies. As part of the work of the task force, a review of the available literature was carried out for each of the following products: Essiac, green tea, Iscador, hydrazine sulfate, vitamins A, C and E, and 714-X. The first article in this series on unconventional therapies for cancer describes the methodology used to obtain and evaluate the information and provides a summary of the findings on Essiac. Subsequent articles will cover the other products. For most of the products reviewed, there has been some indication of possible benefit but no definitive evidence. Innovative and collaborative research needed to meet the information needs of growing numbers of patients and their physicians is now being sponsored by the Canadian Breast Cancer Research Initiative. Open communication between patients and physicians is also necessary for the maintenance of an appropriate therapeutic partnership and for the identification and control of side effects. The Ontario Division of the Canadian Cancer Society, a partner in the Canadian Breast Cancer Research Initiative, supported the preparation of a patient-information piece on unconventional therapies to accompany the series. This item will assist patients who are considering such therapies and will promote open communication between patients and their physicians.

Topics: Breast Neoplasms; Canada; Drug Evaluation; Female; Humans; Indians, North American; Medicine, Traditional; Phytotherapy; Plant Extracts; Plants, Medicinal; Research Design; Treatment Outcome

PubMed: 9559016
DOI: No ID Found

Authors: Barrie Cassileth

Topics: Herb-Drug Interactions; Humans; Neoplasms; Plant Extracts

PubMed: 22106566
DOI: No ID Found

Comparative Study

Authors: Suzanna M Zick, Ananda Sen, Yang Feng...

BACKGROUND

Breast cancer is a major cause of morbidity, mortality, and medical expenditures among women in Canada. Essiac (Resperin Canada Limited, Waterloo, Ontario, Canada), a blend of at least four herbs (burdock root [Arctium lappa], Indian rhubarb [Rheum palmatum], sheep sorrel [Rumex acetosella], and the inner bark of slippery elm [Ulmus fulva or U. rubra]), has become one of the more popular herbal remedies for breast-cancer treatment, secondary prevention, improving quality of life, and controlling negative side-effects of conventional breast-cancer treatment.

OBJECTIVES

Our primary objective was to determine the difference in health-related quality of life (HR-QOL), as assessed by the Functional Assessment of Cancer Therapy Breast Cancer Version, between women who are new Essiac users (since breast cancer diagnosis) and those who have never used Essiac. Secondary endpoints included differences in depression, anxiety, fatigue, rate of adverse events, and prevalence of complications or benefits associated with Essiac during standard breast-cancer treatment. Additionally, we described the pattern of use of Essiac in this cohort of women.

METHODS

We performed a retrospective cohort study in 510 women, randomly chosen from the Ontario Cancer Tumour Registry, with a diagnosis of primary breast cancer in 2003.

RESULTS

With the exception changes in a Physical well-being subscale and a relationship with doctor subscale, Essiac did not have a significant effect on HR-QOL or mood states. Even for Physical well-being and relationship with doctor, Essiac seemed to have a negative effect, with Essiac users doing worse than the non-Essiac users. This might be attributed to the fact that the group of users comprised younger women with more advanced stages of breast cancer, and both of these subgroups of patients have been shown to be at a significantly increased risk for negative mood states and/or a decreased sense of well-being. The women were taking low doses (total daily dose 43.6 +/- 30.8 mL) of Essiac that corresponded to the label directions found on most Essiac products. Friends were the most common source of information, and most women were taking Essiac to boost their immune systems or increase their chances of survival. Only 2 women reported minor adverse events, whereas numerous women reported beneficial effects of Essiac.

CONCLUSIONS

Essiac does not appear to improve HR-QOL or mood states. Future studies are needed to determine whether other clinical outcomes, such as cancer reoccurrence, are affected by Essiac.

Topics: Adult; Affect; Age Factors; Attitude to Health; Breast Neoplasms; Cohort Studies; Disease Progression; Female; Health Knowledge, Attitudes, Practice; Humans; Middle Aged; Ontario; Plant Extracts; Quality of Life; Retrospective Studies; Surveys and Questionnaires; Women's Health

PubMed: 17212569
DOI: 10.1089/acm.2006.12.971

Authors: Dugald Seely, Deborah A Kennedy, Stephen P Myers...

BACKGROUND

Despite the recommendation of the Task Force on Alternative Therapies of the Canadian Breast Cancer Research Initiative, little research has been published on the widely used herbal compound Essiac. We aimed to address this deficiency by conducting a series of assays to determine some of the purported activities of Essiac in vitro.

MATERIALS AND METHODS

The activity of Essiac was measured using established assays to assess anti-oxidant, fibrinolytic, anti-microbial, anti-inflammatory, immune modulation, cell-specific cytotoxicity, and impact on cytochrome P450 (CYP450) enzyme pathways.

RESULTS

Essiac exhibited significant antioxidant activity in the ABTS assay. A 20-fold dilution of Essiac also exhibited significant immunomodulatory effects, specifically through stimulation of granulocyte phagocytosis, increases in CD8+ cell activation, and moderately inhibiting inflammatory pathways. Essiac exhibited significant cell-specific cytotoxicity towards ovarian epithelial carcinoma cells (A2780). Importantly, a 20-fold dilution of Essiac showed significant inhibition of several CYP450 enzymes, most notably CYP1A2 (37%) and CYP2C19 (24%). Essiac demonstrated dose-dependent inhibition of clot fibrinolysis.

CONCLUSION

In vitro analysis of Essiac indicates significant antioxidant and immunomodulatory properties, as well as neoplastic cell specific cytotoxicity consistent with the historical properties ascribed to this compound. Importantly, significant CYP450 and fibrinolysis inhibition were also observed. This is the first comprehensive investigation of the in vitro effects of Essiac.

Topics: Anti-Infective Agents; Antineoplastic Agents, Phytogenic; Antioxidants; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes; Cell Line, Tumor; Cytochrome P-450 Enzyme Inhibitors; Drug Screening Assays, Antitumor; Fibrinolytic Agents; Humans; Lymphocyte Activation; Plant Extracts; Platelet Aggregation

PubMed: 18225545
DOI: No ID Found

Authors: Blair J N Leonard, Deborah A Kennedy, Fong-Chi Cheng...

BACKGROUND

Essiac is a herbal compound that has been in common use with cancer patients in North America for over 80 years. Despite its relatively widespread use, there are no peer-reviewed published reports of in vivo studies regarding the use of this compound.

MATERIALS AND METHODS

Essiac was administered orally to test animals prior to all experiments. Standard assays to test protection from ethanol-induced gastric ulceration and carbon tetrachloride-induced hepatic injury were performed on Wistar rats. Assays of postglucose-load serum glucose and cellular and humoral immune modulation were conducted on ICR and BALB/C mice, respectively.

RESULTS

Essiac demonstrated a modest gastric protective effect via reduction of ethanol-induced gastric ulceration. However, Essiac did not demonstrate significant hepatoprotective, hypoglycemic or immunomodulatory properties.

CONCLUSION

Essiac, administered in established in vivo experimental models, did not significantly demonstrate its purported physiological modifying effects.

Topics: Animals; Blood Glucose; Carbon Tetrachloride Poisoning; Chemical and Drug Induced Liver Injury; Liver Diseases; Male; Mice; Mice, Inbred BALB C; Mice, Inbred ICR; Plant Extracts; Rats; Rats, Wistar; Stomach Ulcer

PubMed: 16886634
DOI: No ID Found

Authors: K S Wilson

BACKGROUND

Cancer patients frequently use alternative therapies. Two follicular lymphoma patients who had objective tumour regression after taking Devil's Claw without cytotoxic therapy are reported here.

METHODS AND RESULTS

Patient 1 presented with coexistent immunoglobulin G plasma cell dyscrasia and stage iiia lymphoma (nodes 5 cm in diameter). Computed tomography scan 10 months later showed partial regression. On enquiry, it was learned that the patient was taking Devil's Claw and Essiac (Essiac Products Services, Pompano Beach, FL, U.S.A.). This patient later developed overt myeloma, at which time he stopped the herbal supplements and underwent high-dose chemotherapy and stem cell transplantation, since which no lymphoma progression has occurred. Patient 2 presented with stage IIIA lymphoma (nodes 2.5 cm in diameter). He learned of patient 1 through our lymphoma patient support group and started Devil's Claw. Computed tomography scan 11 months later showed decreased adenopathy and splenomegaly, which has been sustained for 4 years.

DISCUSSION AND CONCLUSIONS

Devil's Claw tuberous root has anti-inflammatory properties, probably through suppression of cyclooxygenase 2 (COX-2) and inducible nitric oxide synthase expression. There are no prior reports of anticancer activity. Inhibition of COX-2 has a role in colon cancer prevention, has been implicated in lymphomagenesis, and is associated both with lymphoma stage and with response to treatment. However, spontaneous regression in lymphoma has been reported in 16% of patients in one series, of whom none were on herbal medications or COX-2 inhibitors. The key issue in both these patients is whether disease regression was "spontaneous" or causally related to therapy with Devil's Claw. The timing of the response suggests a positive effect. Further investigation is warranted, preferably with a COX-2 inhibitor of known purity.

PubMed: 19672427
DOI: 10.3747/co.v16i4.401