The ASCO Post’s Integrative Oncology series is intended to facilitate the availability of evidence-based information on integrative and complementary therapies commonly used by patients with cancer. We chose Boswellia for this issue because of its increasing use by patients with cancer.
Integrative Oncology is guest edited by Barrie R. Cassileth, MS, PhD, of Memorial Sloan Kettering Cancer Center, New York.
Boswellia serrata is a tropical tree widespread in India, the Middle East, and North Africa and is the source of a fragrant resin known as “frankincense” or “olibanum.” The resin, obtained from the bark, is used as incense in religious ceremonies in many cultures of the world and is also valued for its therapeutic effects. Referred to as Indian frankincense, Boswellia resin is prescribed widely in Ayurveda to treat several conditions, including diarrhea, dysentery, pulmonary disease, arthritis, coughs, sores, snakebite, ringworm, and asthma.
Scientific research over the past few decades has revealed boswellic acids, the major constituents of Boswellia resin, to be responsible for many of the herb’s medicinal properties. Current clinical data suggest the effectiveness of Boswellia against asthma, Crohn’s disease, and rheumatoid arthritis (see The Science section).
Boswellia is available in health food stores and online in the form of tablets, capsules, extracts, and as an ingredient in topical creams and ointments.
Purified extracts of both Boswellia resin and bark are used as a general tonic and also in herbal formulas to treat bacterial infections, osteoarthritis, inflammatory bowel disorders, asthma, and high cholesterol.
In vitro and animal studies indicate that boswellic acid, a penta-cyclic triterpene and a major constituent of Boswellia resin, is a strong inhibitor of 5-lipoxygenase1 and demonstrates anti-inflammatory and antiarthritic effects.1-3 Studies also suggest that it has cytotoxic and antitumor properties.4,5
Jyothirmai Gubili, MS
In clinical trials, a Boswellia preparation, given orally, was shown to be effective in the treatment of bronchial asthma6 and ulcerative colitis.7 But definitive data are lacking to support its utility for osteoarthritis8,9 and collagenous colitis.10 Boswellia also was found to be ineffective in sustaining remission of Crohn’s disease.11
Recent investigations into Boswellia’s anticancer effects showed that when taken orally, it was useful in reducing cerebral edema following radiotherapy in patients with brain tumors,12 and an oral formulation consisting of boswellic acid, betaine, and myo-inositol helped to reduce mammary density, a risk factor for breast cancer.13 In addition, the topical use of a Boswellia-based cream was found to be effective in preventing skin damage due to radiotherapy in patients with breast cancer.14 Larger studies are needed to confirm these data.
Use of a topical cream containing a Boswellia extract resulted in allergic contact dermatitis.15
Excessive intake of frankincense has been associated with a gastric bezoar (accumulation of vegetable fiber, hair, or other substances in the stomach or small intestine) in a 17-year-old girl with celiac disease. The symptoms, which included epigastric pain and vomiting, resolved after the bezoar was surgically removed.16
OATP1B3 (a transporter that is responsible for the hepatic uptake of drugs and endogenous compounds): Two compounds, 11-keto-beta-boswellic acid (KBA) and 3-acetyl-11-keto-beta-boswellic acid (AKBA), were shown to modulate the activity of OATP1B3 in vitro.17
MRP2 (a multidrug-resistant protein): Both KBA and AKBA were also shown to modulate the activity of MRP2 in vitro.17
P-glycoprotein: A Boswellia extract and keto-boswellic acids were shown to inhibit the activity of P-glycoprotein in vitro and may affect the transport of drugs mediated by this mechanism.18
For additional information, visit the “About Herbs” website at https://www.mskcc.org/cancer-care/integrative-medicine/herbs/boswellia. ■
Disclosure: Ms. Gubili reported no potential conflicts of interest.
Compiled by Barrie R. Cassileth, PhD, and Jyothirmai Gubili, MS, Memorial Sloan Kettering Cancer Center. The free About Herbs website is managed by K. Simon Yeung, PharmD, MBA, LAc, Memorial Sloan Kettering Cancer Center.
1. Dahmen U, Gu YL, Dirsch O, et al: Boswellic acid, a potent antiinflammatory drug, inhibits rejection to the same extent as high dose steroids. Transplant Proc 33:539-541, 2001.
2. Safayhi H, Boden SE, Schweizer S, et al: Concentration-dependent potentiating and inhibitory effects of Boswellia extracts on 5-lipoxygenase product formation in stimulated PMNL. Planta Med 66:110-113, 2000.
3. Safayhi H, Mack T, Sabieraj J, et al: Boswellic acids. J Pharmacol Exp Ther 261:1143-1146, 1992.
4. Frank MB, Yang Q, Osban J, et al: Frankincense oil derived from Boswellia carteri induces tumor cell specific cytotoxicity. BMC Complement Altern Med 9:6, 2009.
5. Park B, Prasad S, Yadav V, et al: Boswellic acid suppresses growth and metastasis of human pancreatic tumors in an orthotopic nude mouse model through modulation of multiple targets. PLoS One 6:e26943, 2011.
6. Gupta I, Gupta V, Parihar A, et al: Effects of Boswellia serrata gum resin in patients with bronchial asthma. Eur J Med Res 3:511-514, 1998.
7. Gupta I, Parihar A, Malhotra P, et al: Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res 2:37-43, 1997.
8. Chrubasik JE, Roufogalis BD, Chrubasik S: Evidence of effectiveness of herbal antiinflammatory drugs in the treatment of painful osteoarthritis and chronic low back pain. Phytother Res 21:675-683, 2007.
9. Sengupta K, Alluri KV, Satish AR, et al: A double blind, randomized, placebo controlled study of the efficacy and safety of 5-Loxin for treatment of osteoarthritis of the knee. Arthritis Res Ther 10:R85, 2008.
10. Chande N, MacDonald JK, McDonald JW: Interventions for treating microscopic colitis. Am J Gastroenterol 104:235-241, 2009.
11. Holtmeier W, Zeuzem S, Preiss J, et al: Randomized, placebo-controlled, double-blind trial of Boswellia serrata in maintaining remission of Crohn’s disease. Inflamm Bowel Dis 17:573-582, 2011.
12. Kirste S, Treier M, Wehrle SJ, et al: Boswellia serrata acts on cerebral edema in patients irradiated for brain tumors. Cancer 117:3788-3795, 2011.
13. Pasta V, Gullo G, Giuliani A, et al: An association of boswellia, betaine and myo-inositol in the treatment of mammographic breast density. Eur Rev Med Pharmacol Sci 19:4419-4426, 2015.
14. Togni S, Maramaldi G, Bonetta A, et al: Clinical evaluation of safety and efficacy of Boswellia-based cream for prevention of adjuvant radiotherapy skin damage in mammary carcinoma. Eur Rev Med Pharmacol Sci 19:1338-1344, 2015.
15. Acebo E, Ratón JA, Sautúa S, et al: Allergic contact dermatitis from Boswellia serrata extract in a naturopathic cream. Contact Dermatitis 51:91-92, 2004.
16. El Fortia M, Badi H, Elalem Kh, et al: Olibanum bezoar. East Mediterr Health J 12:927-929, 2006.
17. Krüger P, Kanzer J, Hummel J, et al: Permeation of Boswellia extract in the Caco-2 model and possible interactions of its constituents KBA and AKBA with OATP1B3 and MRP2. Eur J Pharm Sci 36:275-284, 2009.
18. Weber CC, Reising K, Müller WE, et al: Modulation of Pgp function by boswellic acids. Planta Med 72:507-513, 2006.