Category Archives: inhibits chemotherapy-induced cardiotoxicity

Anti-tumoral, Chapter 8 Injectables and Cancer Research, Chemotherapy, chemotherapy support, CYP1A2, inhibits chemotherapy-induced cardiotoxicity, inhibits CYP activity, Nausea and Vomiting

Shenmai

Cancers: Lung, stomach

Action: Anti-tumoral., chemotherapy support, inhibits CYP activity, inhibits chemotherapy-induced cardiotoxicity

Shenmai injection (SMI) is a mixture of Radix Ginseng and Radix Ophiopogonis, comprised of total ginsenoside (TG), ophiopogon total saponins (OTS), ophiopogon total flavone (OTF), ginsenoside Rd, ophiopogonin D and ophiopogonone A.

NSCLC

Forty-five NSCLC patients, with stages IIIb-IV, were randomly divided into two groups: the treatment group (treated with chemotherapy combined with Shenmai injection) and the control group (treated with chemotherapy only). There was no significant difference between the two groups in acute curative effects (P > 0.05). However, there were significant differences between them in Karnofsky score and weight (P < 0.05). The treatment group was significantly better than the control group in preventing leukopenia and decreased hemoglobin (P < 0.05). The incidence of thrombocytopenia, nausea and vomiting, hepatic, and renal dysfunction in the treatment group was lower than that in the control group.

Shenmai injection would not influence the efficacy of chemotherapy in advanced NSCLC patients. However, it could improve the quality of life, increase the body weight of patients, and alleviate adverse reactions of chemotherapy, such as myelosuppression, to improve chemotherapy tolerance (Cao, Li, & Tan, 2006).

Hepatic CYP Enzymes

These in vivo and in vitro results demonstrated that Shenmai had the potential to inhibit the activities of hepatic CYP3A1/2 and CYP2C6, but might not significantly affect CYP1A2 and CYP2E1-mediated metabolism in rats (Xia et al., 2010).

Gastric Cancer; Chemotherapy

Sixty-seven patients with gastric cancer in medium to advanced stage were randomly divided into two groups: 33 cases in the treatment group and 34 cases in the control group. The control group was treated with docetaxel, oxaliplatin and fluorouracil (DOF), while the treatment group was treated with DOF and Shenmai injection (40 mL / day). One treatment course included 21 days, and after 2 treatment courses the results were observed.

There was significant difference between the two groups (X2=4.327 6, P < 0.05). Additionally, there was statistically significant difference in the Karnofsky score (u=2.7033, P=0.008 4) and syndrome evaluation (u=2.375 9, P=0.018 0).

Shenmai injection, combined with chemotherapy, has better effect on gastric cancer in medium to advanced stage than single chemotherapy alone. It has a reliable effect on tumor mass but the benefits in regards to the rate of chemotherapy completion and Kanorfsky animation score is not definite (OR and 95% CI are over 1) (Hao, Liu, Wang, Li, & Li, 2013).

Cardiotoxicity

Six RCTs were included, totaling 615 patients (307 in the experimental group and 308 in the control group). Current evidence suggests that Shenmai injection is potentially effective in the prevention and treatment of cardiotoxicity in tumor patients induced by anthracyclines (Yang, Lu, Mou, & Xu, 2012).

NSCLC

All patients were treated with the Navelbine and Cisplatin (NP) chemotherapy, but to the treatment group the Chinese drugs Shengmai Injection by intravenous drip and Gujin Granule by oral intake were given additionally. The main observation indexes were response rate (RR), median survival time, 1-year survival rate and median time to progression (TTP); secondary observation indexes were side-effects and cycles of chemotherapy.

RR was 48.5% in the treatment group and 32.2% in the control group, and the median survival times were 13 months and 9 months, respectively. However, the differences between groups were insignificant in terms of 1-year survival rate [51.5% vs 46.4%, P=0.4042], median TTP (5.95 months vs 4.64 months, P=0.3242), grade III or IV bone marrow inhibition occurrence rate [33.3% (11/33) vs 39.3% (11/28), P=0.3500], and mean cycles of chemotherapy applied (2.94+/-0.94 cycles vs 2.75+/-0.75 cycles, P=0.4100).

Combined Chinese drugs and chemotherapy can enhance the short-termtherapeutic efficacy in the treatment of NSCLC and prolong patients” median survival time (Chen et al., 2009).

References

Cao, Y., Li, P., & Tan, K.J. (2006). Clinical observation on Shenmai injection in preventing and treating adverse reaction of chemotherapy on advanced non-small-cell lung cancer. Chinese Journal of Integrated Traditional and Western Medicine, 26(6), 550-552.


Chen YZ, Li ZD, Gao F, Zhang Y, Sun H, Li PP. (2009) Effects of combined Chinese drugs and chemotherapy in treating advanced non-small-cell lung cancer. Chin J Integr Med, 15(6):415-9.


Hao, S.L, Liu, L.K., Wang, X.X., Li, J., & Li, Y.F. (2013). Clinical research of Shenmai injection combined with chemotherapy on gastric cancer in medium-advanced stage, A Report of 33 Cases. Shaanxi Journal of Chinese Traditional Medicine, 29(2), 9-11.


Xia, C.H., Sun, J.G., Wang, G.J., Shang, L.L., Zhang, X.X., Zhang, R., Peng, Y., Wang, X.J., Hao, H.P., Xie, L., & Roberts, M.S. (2010). Herb-drug interactions: in vivo and in vitro effect of Shenmai injection, a herbal preparation, on the metabolic activities of hepatic cytochrome P450 3A1/2, 2C6, 1A2, and 2E1 in rats. Planta Medica, 76(3), 245-50. doi: 10.1055/s-0029-1186082.


Yang, M., Lu, J., Mou, J.J., & Xu, T. (2012). Systematic review of Shenmai injection for cardiotoxicity induced by anthracyclines. Chinese Journal of Pharmacovigilance, 9(11), 666-669.