The problem of the relationship with Complementary Medicine, in this historical moment, is very much conditioned by the debate around the evidence and the methodologies with which they are obtained. As we know, in oncology, treatment and research are essentially focused on cancer. In complementary medicine, the disease is seen in a more dynamic way as the clash between the cancer disease and the body's antipathogenic resistance factors. This simple change of view allows for several operations. First of all, it becomes possible to try to trace personalized therapy paths for cancer disease for each patient because, if on the one hand it is clear that we must fight the tumor, on the other it is no less important to support the organism in its battle which is a psychological, immunological and endocrinological battle. Secondly, if the resources for this clash are to be sought in a 360 ° vision of man, it is clear that the promotion of a patient's quality of life, even during illness, is no less important than the search for health, which can be connected to the first in a much closer way than is usually believed. And often there may be valuable resources in the patient to mobilize for the pursuit of healing. Last but not least, the body's ability to resist therapy, for example to chemotherapy cycles, can be improved by producing a true synergy between herbal remedies and the usual conventional therapies. The phytotherapy of the two lines of treatment (1- fight cancer, 2- support the body) has above all developed the second with better success, which is closely connected with the so-called palliative therapies.
The main areas that phytotherapy can address in the field of oncological palliative care are:
• 1) asthenia and weakness
• 2) psycho-organic wasting.
• 3) pain in general.
• 4) nausea and vomiting.
• 5) radiation therapy dermatitis.
• 6) anxious depressive syndrome and sleep disturbances.
• 7) immunosuppression.
• 8) gastrointestinal disorders.
Although in the practice of phytotherapy the experience related to supportive therapy to chemotherapy or other anticancer therapies is prevalent, this does not mean that there are numerous lines of research aimed at highlighting possible anticancer activities by herbs traditionally used for purposes, often, also very different. Among the main ones we can mention:
The Curcuma rhizome, which contains a mixture of triterpene saponins, called curcuminoids, has been shown to have chemopreventive and growth inhibiting activities against various tumor cell lines. It seems to induce apoptosis in cancer cells and can inhibit angiogenesis. Curcumin also inhibits the activation of NF-KappaB and the expression of genes regulated by NF-KappaB itself. It has numerous in vitro and animal studies regarding its antineoplastic action, which seems mainly aimed at cancers of the digestive system and in particular those of the large intestine and liver. Interesting clinical data are also available for prostatic, mammary, uterine, cutaneous neoplasms, glioblastomas and leukemias [1-13].
Resveratrol and the polyphenols present in this drug are capable of inducing cellular apoptosis, especially through a p53 mediated mechanism. Resveratrol is able to hinder the growth of numerous types of cancer cells (lymphoid and myeloid carcinomas, multiple myeloma, carcinoma of the breast, prostate, stomach, colon, pancreas, thyroid, melanoma, squamous carcinoma of the head and of the neck, ovarian cancer and cervical cancer. It causes in these cells the arrest of cell cycle progression with the activation of caspases. Resveratrol is capable of inhibiting the activation of nuclear transcription factors such as NF-KappaB, AP-1 and Egr-1 and to inhibit protein kinases. It also causes a down-regulation of the products of certain genes such as COX2, 5-LOX, VEGF, Il1, IL6, IL8, AR and PSA. In vitro studies indicate that the polyphenols of wine can reduce angiogenesis by hindering the proliferation and migration of endothelial cells and smooth muscle cells and the expression of two fundamental proangiogenic factors. Resveratrol enhances the apoptotic effects of some chemotherapy drugs and of the radiation therapy. Toxicology data indicate that it appears to be reasonably safe in humans and has very few side effects [14-21].
This plant and its extracts rich in isoflavones have very interesting properties in the oncology sector. Genistein reduces the formation of new blood vessels. Neoplasms, on the other hand, need a lot of blood, so this anti-angiogenic effect of phytoestrogens can help explain their anticancer effect. Tyrosine kinase inhibitors are known to have antineoplastic effects, but their toxicity is quite significant. Instead genistein, which is a natural inhibitor of this enzyme present in soy flour in quantities of 1-2 mg / g. of flour, does not appear to have toxic effects even at a dose of 200 mg / day, and appears to have a protective effect against breast, colon, prostate and female genital tract neoplasms. Furthermore, soy isoflavones can increase the amount of estrogen transformed from the active to the sulphated form, which is much less active in human tissues. Genistein causes a down-regulation of the MDM2 oncogene, and this mechanism of action seems very important to explain its antitumor action. Genistein is capable of optimizing the extrarenal synthesis of vitamin D3, which helps to slow down the growth of breast, colon and prostate tumors thanks to its antimitotic action. Finally, soy isoflavones have a powerful antioxidant / anti-radical action, which hinders the pro-tumor cell damage linked to free radicals. Numerous clinical studies and meta-analisys have evaluated the antineoplastic effect of soy isoflavones, generally with very promising results [22-42].
It has an antimutagenic action, as, for example, it decreases the mutagenic activity of benzopyrene. This action appears to be due to direct inhibition of liver microsome activation and not to interaction with benzopyrene metabolites and / or DNA repair processes. Furthermore, some substances contained in this drug have cytotoxic, antiproliferative and proapoptotic action. The neoplasms that appear to be most sensitive to this drug are those of the digestive system, lung and skin [43-50].
The polyphenols of green tea, and in particular the catechins epigallocatechin-3-gallate (EGCG), epigallocatechin (EGC) and epicatechin-3-gallate (ECG) make up 30-40% of the components of green tea extract and may have anticancer action. It is due to their strong antioxidant action, the stimulation of phase 1 and phase 2 detoxifying enzymes, the inhibition of tumor initiation and promotion markers and the inhibition of cell replication. The anticancer action of green tea has been studied on tumors of the esophagus, skin, mouth, colon, stomach, liver, pancreas, small intestine, bladder, prostate and breast. The main constituents for carrying out this action are polyphenols and in particular EGCG. Green tea hinders cell proliferation, induces apoptosis and stimulates the activity of endogenous detoxifying enzymes. Moreover, it must be said that the results of the in vitro studies are not fully transposable in vivo and that the clinical studies carried out so far have quite contradictory results [51-74].
In addition to the above in a nutshell, phytotherapy can act as a complementary therapy in the neoplastic patient in the following fields of action:
• Stimulation of the body's non-specific immune defenses, with particularly evident effects on neutrophil granulocytes, macrophages, monocytes and NK cells.
• Prebiotic action in the intestine, with improvement of the trophism of the intestinal bacterial flora and consequent improvement of intestinal immunity, which as known is of crucial importance in particular in adults. It can also hinder the depletion of intestinal bacterial flora induced by chemotherapy and radiotherapy.
• A tonic and energizing action on both a psychic and physical level, very useful for fighting the profound asthenia induced by neoplasms and anticancer therapies. In this sense it can also favor the feeding of the neoplastic patient.
• Antiemetic and gastroprotective action, particularly useful in patients receiving anticancer therapy.
• Protective action on the skin against skin damage caused for example by radiotherapy.
• Antioxidant / anti-radical action at the level of the whole organism.
• Action of synergy and enhancement of the effects of some anticancer drugs and radiotherapy.
All these effects are proven by scientific literature, in many cases still limited but susceptible to enormous developments. I therefore think that the fields of action that could be proposed are many and of great scientific interest, obviously always in the context of complementary and / or palliative therapy of the neoplastic patient.
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