Ginseng in the management of cancer
Abstract and key points
- Asian and American ginseng (P. ginseng and P. quinquefolius) are frequently used medicinal plants
- Evidence is available that ginseng helps against cancer-related fatigue
- Preliminary evidence suggests a benefit of ginseng against infections complications
- Evidence that ginseng works as an anti-cancer agent or protects from chemotherapy-associated adverse effects is weak
- P. ginseng and P. quinquefolius appear to be well tolerated
This summary reports on the most prevalently used species of the genus Panax (C. Linnaeus): Korean or Asian ginseng (Panax ginseng) and American ginseng (Panax quinquefolius)
Ginseng is claimed to be an adaptogen, which enhances the “state of non-specific resistance” in stress. Ginsenosides, which are steroid glycosides comprising of a sugar and a triterpene part are the putative main active compounds of ginseng.
In traditional medicine it is used as a tonic for strengthening and invigoration in cases of fatigue and weakness as well as for reduced performance and concentration. In some countries, preparations of Asian and American ginseng are available as licensed drugs.
There is evidence from several randomized controlled trials that extracts from both ginseng species helps against cancer-related fatigue. Preliminary evidence suggests that P. quinquefolius might be of benefit to prevent respiratory infections in patients with chronic lymphocytic leukaemia. The evidence that extracts from Panax species prolongs survival, has impact on tumour response, reduces chemotherapy-associated adverse effects or increases quality of life is weak. Ginseng is usually well tolerated with only minor and easily reversible adverse effects.
|Citation||Markus Horneber, CAM-Cancer Consortium. Ginseng (Panax ginseng, P. quinquefolium) [online document]. http://ws.cam-cancer.org/The-Summaries/Herbal-products/Ginseng-Panax-ginseng-P.-quinquefolium. October 20, 2014.|
- Jia L, Zhao Y: Current evaluation of the millennium phytomedicine--ginseng (I): etymology, pharmacognosy, phytochemistry, market and regulations. Curr Med Chem 2009; 16(19):2475-2484.
- Christensen LP: Chapter 1 ginsenosides chemistry, biosynthesis, analysis, and potential health effects. Adv Food Nutr Res 2008; 55:1-99.
- Court WE: Ginseng - The genus panax. Amsterdam, Harwood Scientific Publishers, 2000.
- Hasegawa H: Proof of the Mysterious Efficacy of Ginseng: Basic and Clinical Trials: Metabolic Activation of Ginsenoside: Deglycosylation by Intestinal Bacteria and Esterification With Fatty Acid. J Pharmacol Sci 2004; 95(2):153-157.
- Sticher O: Saponine; in: Hänsel R, Sticher O, (eds): Pharmakognosie, Phytopharmazie. Heidelberg, Springer Verlag, 2009, pp 943-989.
- Monographie BGA/BfArM (Kommission E): Ginseng root (Ginseng radix). Bundesanzeiger 1991; 11(ATC-Code: N07XF).
- Barton DL, Liu H, Dakhil SR, Linquist B, Sloan JA, Nichols CR, McGinn TW, Stella PJ, Seeger GR, Sood A, Loprinzi CL: Wisconsin Ginseng (Panax quinquefolius) to Improve Cancer-Related Fatigue: A Randomized, Double-Blind Trial, N07C2. J Natl Cancer Inst 2013.
- High KP, Case D, Hurd D, Powell B, Lesser G, Falsey AR, Siegel R, Metzner-Sadurski J, Krauss JC, Chinnasami B, Sanders G, Rousey S, Shaw EG: A randomized, controlled trial of Panax quinquefolius extract (CVT-E002) to reduce respiratory infection in patients with chronic lymphocytic leukemia. J Support Oncol 2012; 10(5):195-20
- Fulder S: Book of Ginseng. Rochester, 1993.
- Jia L, Zhao Y, Liang XJ: Current Evaluation of the Millennium Phytomedicine- Ginseng (II): Collected Chemical Entities, Modern Pharmacology, and Clinical Applications Emanated from Traditional Chinese Medicine. Curr Med Chem 2009; 16(22):2924-2942.
- Kitts DD, Hu C: Efficacy and safety of ginseng. Public Health Nutr 2000; 3(4A):473-485.
- Panossian A, Wikman G, Wagner H: Plant adaptogens. III. Earlier and more recent aspects and concepts on their mode of action. Phytomedicine 1999; 6(4):287-300.
- WHO. WHO monographs on medicinal plants commonly use in the Newly Independent States (NIS). 2010. Geneva, WHO Press.
- Rasheed N, Tyagi E, Ahmad A, Siripurapu KB, Lahiri S, Shukla R, Palit G: Involvement of monoamines and proinflammatory cytokines in mediating the anti-stress effects of Panax quinquefolium. J Ethnopharmacol 2008; 117(2):257-262.
- Radad K, Moldzio R, Rausch WD: Ginsenosides and their CNS targets. CNS Neurosci Ther 2011; 17(6):761-768.
- Panossian A, Wikman G: Effects of Adaptogens on the Central Nervous System and the Molecular Mechanisms Associated with Their Stress-Protective Activity. Pharmaceuticals 2010; 3:188-224.
- Chen CK, Muhamad AS, Ooi FK: Herbs in exercise and sports. J Physiol Anthropol 2012; 31:4.
- Liu TG, Huang Y, Cui DD, Huang XB, Mao SH, Ji LL, Song HB, Yi C: Inhibitory effect of ginsenoside Rg3 combined with gemcitabine on angiogenesis and growth of lung cancer in mice. BMC Cancer 2009; 9:250.
- Zhang Q, Kang X, Yang B, Wang J, Yang F: Antiangiogenic effect of capecitabine combined with ginsenoside Rg3 on breast cancer in mice. Cancer Biother Radiopharm 2008; 23(5):647-653.
- Dougherty U, Mustafi R, Wang Y, Musch MW, Wang CZ, Konda VJ, Kulkarni A, Hart J, Dawson G, Kim KE, Yuan CS, Chang EB, Bissonnette M: American ginseng suppresses Western diet-promoted tumorigenesis in model of inflammation-associated colon cancer: role of EGFR. BMC Complement Altern Med 2011; 11:111.
- Du J, Cheng B, Zhu X, Ling C: Ginsenoside Rg1, a novel glucocorticoid receptor agonist of plant origin, maintains glucocorticoid efficacy with reduced side effects. J Immunol 2011; 187(2):942-950.
- He BC, Gao JL, Luo X, Luo J, Shen J, Wang L, Zhou Q, Wang YT, Luu HH, Haydon RC, Wang CZ, Du W, Yuan CS, He TC, Zhang BQ: Ginsenoside Rg3 inhibits colorectal tumor growth through the down-regulation of Wnt/ss-catenin signaling. Int J Oncol 2011; 38(2):437-445.
- Gao JL, Lv GY, He BC, Zhang BQ, Zhang H, Wang N, Wang CZ, Du W, Yuan CS, He TC: Ginseng saponin metabolite 20(S)-protopanaxadiol inhibits tumor growth by targeting multiple cancer signaling pathways. Oncol Rep 2013; 30(1):292-298.
- Wang CZ, Li B, Wen XD, Zhang Z, Yu C, Calway TD, He TC, Du W, Yuan CS: Paraptosis and NF-kappaB activation are associated with protopanaxadiol-induced cancer chemoprevention. BMC Complement Altern Med 2013; 13:2.
- Marles RJ, Farnsworth NR: Antidiabetic plants and their active constituents. Phytomedicine 1995; 2(2):137-189.
- European Pharmacopoeia Commission. Ginseng dry extract quantified. Monograph No.2356 13A/T (08) 81 ANP. 2010.
- Lu P, Su W, Miao ZH, Niu HR, Liu J, Hua QL: Effect and mechanism of ginsenoside Rg3 on postoperative life span of patients with non-small cell lung cancer. Chin J Integr Med 2008; 14(1):33-36.
- Chen ZJ, Cheng J, Huang YP, Han SL, Liu NX, Zhu GB, Yao JG: [Effect of adjuvant chemotherapy of ginsenoside Rg3 combined with mitomycin C and tegafur in advanced gastric cancer]. Zhonghua Wei Chang Wai Ke Za Zhi 2007; 10(1):64-66.
- Huang JY, Sun Y, Fan QX, Zhang YQ: [Efficacy of Shenyi Capsule combined with gemcitabine plus cisplatin in treatment of advanced esophageal cancer: a randomized controlled trial]. Zhong Xi Yi Jie He Xue Bao 2009; 7(11):1047-1051.
- Barton DL, Soori GS, Bauer BA, Sloan JA, Johnson PA, Figueras C, Duane S, Mattar B, Liu H, Atherton PJ, Christensen B, Loprinzi CL: Pilot study of Panax quinquefolius (American ginseng) to improve cancer-related fatigue: a randomized, double-blind, dose-finding evaluation: NCCTG trial N03CA. Support Care Cancer 2010; 18(2):179-187.
- Kim JH, Park CY, Lee SJ: Effects of sun ginseng on subjective quality of life in cancer patients: a double-blind, placebo-controlled pilot trial. J Clin Pharm Ther 2006; 31(4):331-334.
- Younus J, Collins A, Wang X, Saunders M, Manuel J, Freake C, Defen P. A double blind placebo controlled pilot study to evaluate the effect of ginseng on fatigue and quality of life in adult chemo-naïve cancer patients. Proc Am Soc Clin Oncol 22. 2003. 23-7-2008.
- Torbey E, Rafeh NA, Khoueiry G, Kowalski M, Bekheit S: Ginseng: a potential cause of long QT. J Electrocardiol 2010; 44(3):357-358.
- Chang YS, Seo EK, Gyllenhaal C, Block KI: Panax ginseng: a role in cancer therapy? Integr Cancer Ther 2003; 2(1):13-33.
- Seely D, Dugoua JJ, Perri D, Mills E, Koren G: Safety and efficacy of panax ginseng during pregnancy and lactation. Can J Clin Pharmacol 2008; 15(1):e87-e94.
- Shin S, Jang JY, Park D, Yon JM, Baek IJ, Hwang BY, Nam SY, Yun YW, Kim KY, Joo SS, Kim YB: Korean red ginseng extract does not cause embryo-fetal death or abnormalities in mice. Birth Defects Res B Dev Reprod Toxicol 2010; 89(1):78-85.
- Toxicology and Carcinogenesis Studies of Ginseng (CAS No. 50647-08-0) in F344/N Rats and B6C3F1 Mice (Gavage Studies): Natl Toxicol Program Tech Rep Ser 2011;(564):1-150.
- Brown R: Potential interactions of herbal medicines with antipsychotics, antidepressants and hypnotics. Eur J Herbal Med 1997; 3:25-28.
- Wiklund IK, Mattsson LA, Lindgren R, Limoni C: Effects of a standardized ginseng extract on quality of life and physiological parameters in symptomatic postmenopausal women: a double-blind, placebo-controlled trial. Swedish Alternative Medicine Group. Int J Clin Pharmacol Res 1999; 19(3):89-99.
- Izzo AA, Ernst E: Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs 2009; 69(13):1777-1798.
- Goey AK, Mooiman KD, Beijnen JH, Schellens JH, Meijerman I: Relevance of in vitro and clinical data for predicting CYP3A4-mediated herb-drug interactions in cancer patients. Cancer Treat Rev 2013.
- Hermann R, von RO: Clinical evidence of herbal drugs as perpetrators of pharmacokinetic drug interactions. Planta Med 2012; 78(13):1458-1477.
- Malati CY, Robertson SM, Hunt JD, Chairez C, Alfaro RM, Kovacs JA, Penzak SR: Influence of Panax ginseng on cytochrome P450 (CYP)3A and P-glycoprotein (P-gp) activity in healthy participants. J Clin Pharmacol 2012; 52(6):932-939.
- Sheen E, Triadafilopoulos G: Adverse effects of long-term proton pump inhibitor therapy. Dig Dis Sci 2011; 56(4):931-950.
- Lee J, Lee E, Kim D, Lee J, Yoo J, Koh B: Studies on absorption, distribution and metabolism of ginseng in humans after oral administration. J Ethnopharmacol 2009; 122(1):143-148.
- Bilgi N, Bell K, Ananthakrishnan AN, Atallah E: Imatinib and Panax ginseng: a potential interaction resulting in liver toxicity. Ann Pharmacother 2010; 44(5):926-928.
- ConsumerLab.com. Product Review: Ginseng Supplements. https://www.consumerlab.com/reviews/Ginseng_Supplements/ginseng/ accessed: 26.07.2013.
- Ernst E (2004) Prescribing herbal medications appropriately. J Fam Pract 53: 985–988
- Cui Y et al. Association of ginseng use with survival and quality of life among breast cancer patients. Am J Epidemiol. 2006 Apr 1;163(7):645-53. Epub 2006 Feb 16
- Zhu J et al. Treat Non-small Cell Lung Cancer with Shenyi Capsule plus Chemotherapy:A Systematic Review. Journal of Liaoning University of Traditional Chinese Medicine 2009-09 (http://en.cnki.com.cn/Article_en/CJFDTOTAL-LNZY200909001.htm)
- Hu S et al. A Meta-analysis of Ginsenoside Rg3 for Non-small Cell Lung Cancer. Clin Oncol Cancer Res (2011) 8: 175–180 DOI 10.1007/s11805-011-0578-4
The present documentation has been compiled by the CAM-CANCER Project with all due care and expert knowledge. However, the CAM-CANCER Project provides no assurance, guarantee or promise with regard to the correctness, accuracy, up-to-date status or completeness of the information it contains. This information is designed for health professionals. Readers are strongly advised to discuss the information with their physician. Accordingly, the CAM-CANCER Project shall not be liable for damage or loss caused because anyone relies on the information.