Herb-drug interactions in oncology: Focus on mechanisms of induction
Herb-drug interactions in oncology: Focus on mechanisms of induction
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DOI：
10.1634/theoncologist.11-7-742
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发表时间：
2006-07-01
期刊：
影响因子：
5.8
通讯作者：
Schellens, Jan H. M.
中科院分区：
文献类型：
--
作者：
Meijerman, Irma;Beijnen, Jos H.;Schellens, Jan H. M.
越来越多的癌症患者正在使用补充和替代药物（CAM）与他们的常规化疗治疗相结合。考虑到溶瘤药物的治疗窗较窄，这种CAM的使用增加了临床相关草药-抗癌药物相互作用的风险。这种相关的相互作用是圣约翰草与抗癌药物伊立替康和伊马替尼的相互作用。然而，据估计，CAM-抗癌药物相互作用是负责实质上更多的化疗药物的意外毒性和可能的治疗不足看到在癌症patients.Induction的药物代谢酶和ATP结合盒药物转运蛋白可能是CAM-抗癌药物相互作用背后的机制之一。由于抗癌药物的血浆水平较低，诱导通常会导致治疗失败，并且在治疗失败常见的癌症治疗中很容易被忽视。最近发现的核受体，例如孕烷X受体、组成性雄甾烷受体和维生素D结合受体，在诱导代谢酶和药物转运蛋白方面发挥着重要作用。这些知识已经帮助鉴定了一些可能能够与抗癌药物相互作用的CAM：卡瓦胡椒，维生素E，槲皮素，人参，大蒜，β-胡萝卜素和紫锥菊。显然，需要更多的研究来防止癌症患者的治疗失败和毒性，并建立CAM使用指南。
An increasing number of cancer patients are using complementary and alternative medicines (CAM) in combination with their conventional chemotherapeutic treatment. Considering the narrow therapeutic window of oncolytic drugs, this CAM use increases the risk of clinically relevant herb-anticancer drug interactions. Such a relevant interaction is that of St. John's wort with the anticancer drugs irinotecan and imatinib. It is, however, estimated that CAM-anticancer drug interactions are responsible for substantially more unexpected toxicities of chemotherapeutic drugs and possible undertreatment seen in cancer patients.Induction of drug-metabolizing enzymes and ATP-binding cassette drug transporters can be one of the mechanisms behind CAM-anticancer drug interactions. Induction will often lead to therapeutic failure because of lower plasma levels of the anticancer drugs, and will easily go unrecognized in cancer treatment, where therapeutic failure is common.Recently identified nuclear receptors, such as the pregnane X receptor, the constitutive androstane receptor, and the vitamin D-binding receptor, play an important role in the induction of metabolizing enzymes and drug transporters. This knowledge has already been an aid in the identification of some CAM probably capable of causing interactions with anticancer drugs: kavakava, vitamin E, quercetin, ginseng, garlic, beta-carotene, and echinacea. Evidently, more research is necessary to prevent therapeutic failure and toxicity in cancer patients and to establish guidelines for CAM use.