Benefit–risk profile of black cohosh (isopropanolic Cimicifuga racemosa extract) with and without St John’s wort in breast cancer patients

Abstract

Endocrine therapy in breast cancer survivors can cause severe ‘climacteric’ symptoms, which may compromise therapy adherence. To determine whether such symptoms can be treated with herbal medication containing black cohosh in the form of isopropanolic Cimicifuga racemosa extract (iCR) alone or in fixed combination with St John’s wort (Hypericum perforatum [HP]) (iCR + HP), a systematic literature search was conducted. Results were viewed in relation to experimental data and metabolism of endocrine therapies. Most breast cancer survivors receiving endocrine therapy experienced reductions in climacteric symptoms under iCR/iCR + HP. Tamoxifen’s interference potential may be countered by using higher iCR doses or iCR + HP. No estrogen-like effects at the breast or on hormones were seen. After breast cancer, even if receiving tamoxifen, patients using iCR/iCR + HP had significantly increased recurrence-free survival rates compared to non-users. These results are substantiated by experimental data demonstrating antiproliferative and anti-invasive effects of iCR in breast cancer cells and enhancement of the antineoplastic effects of tamoxifen. There are no known clinical interactions for iCR and HP with endocrine therapies. The HP extract used in iCR + HP did not exhibit any clinically relevant interaction potential. In conclusion, with its positive benefit–risk profile, iCR/iCR + HP may offer a safe non-hormonal therapeutic option for breast cancer survivors receiving endocrine therapy.

摘要

乳腺癌幸存者的内分泌治疗可导致严重的“更年期”症状, 这可能会影响其治疗的依从性。为了明确这些症状是否可以被黑升麻-异丙醇提取的美类叶生麻提取物(iCR)单独应用或联合圣约翰草(贯叶连翘(HP）(iCRþHP)缓解, 我们进行了系统的文献检索。主要对内分泌治疗的实验数据和代谢结果进行搜集。大多数乳腺癌幸存者接受内分泌治疗后应用iCR / iCRþHP能够减轻更年期症状。他莫西芬对iCR或iCRþHP减轻更年期症状的潜在干扰可以通过应用更大剂量的iCR或iCRþHP抵消。该治疗方案没有在乳房或激素水平上发现雌激素样作用。接受他莫昔芬治疗的乳腺癌患者, 应用iCR / iCRþHP的存活率显著增加。这些结果通过实验数据证实了iCR在乳腺癌细胞中的抗增殖和抗侵袭作用, 而且其能增强他莫西芬的抗肿瘤作用。目前尚未发现iCR和HP与内分泌治疗存在相互作用。用于iCRþHP的HP提取液未表现出任何临床相关的干扰作用。总之, iCR / iCRþHP可能为接受内分泌治疗的乳腺癌幸存者提供一个安全的非激素治疗选择。

Keywords:

• Black cohosh
• Cimicifuga racemosa
• isopropanolic
• Hypericum perforatum
• St John’s wort
• safety
• breast cancer
• tamoxifen
• benefit–risk profile

Conflict of interest

A. O. Mueck, X. Ruan, and A.-M. Beer report no conflict of interest. B. Naser and S. Pickartz are employees of Schaper & Brümmer, the manufacturer of iCR/iCR + HP. The authors alone are responsible for the content and writing of this article.

Additional information

Funding

Nil.