Guest Editor
Integrative Oncology is guest edited by Barrie R. Cassileth, MS, PhD, Chief of the Integrative Medicine Service and Laurance S. Rockefeller Chair in Integrative Medicine at Memorial Sloan-Kettering Cancer Center, New York.
The Integrative Medicine Service at Memorial Sloan-Kettering Cancer Center developed and maintains a free website—About Herbs (www.mskcc.org/aboutherbs)—that provides objective and unbiased information about herbs, vitamins, minerals, and other dietary supplements, and unproved anticancer treatments. Each of the 265 and growing number of entries offer health-care professional and patient versions, and entries are regularly updated with the latest research findings.
In addition, the About Herbs app, Memorial Sloan-Kettering Cancer Center’s very first mobile application, was launched last fall. In the week following its release on September 21, the app was downloaded more than 6,300 times, making it #4 on the top new medical apps chart. The app is compatible with iPad, iPhone, and iPod Touch devices, and can be downloaded at http://itunes.apple.com/us/app/about-herbs/id554267162?mt=8.
Ginseng
Scientific name: Panax ginseng
Common names: Chinese ginseng, ren shen, Korean ginseng, red ginseng
Overview
Panax ginseng is a slow-growing perennial plant indigenous to Northeast Asia. The root is treasured for its medicinal properties and has a history spanning several centuries. Traditional Chinese Medicine practitioners believe that ginseng promotes Yang (eg, male, hot, and positive) qualities. It is used, often in herbal formulas, as a revitalizing agent to improve strength, stamina, and endurance, and to treat fatigue, cardiovascular disorders, diabetes, sexual dysfunction, and cancer.
Ginseng is available in health food stores in the form of tablets, capsules, extracts, teas, and creams for external use. Although fresh ginseng root is sometimes chewed and preserved in wine for consumption, it is marketed primarily in dried form, either whole or sliced.
Panax ginseng should not be confused with American ginseng or Siberian ginseng, which have different medicinal properties.
Also, because ginseng is expensive, adulteration with morphologic fakes and cheaper products is common.
The Science
Ginsenosides, the saponin glycosides present in ginseng root and other parts of the plant, are thought to be responsible for ginseng’s medicinal effects.1 Recent studies indicate that they also have anticancer properties in vitro.2
P ginseng has been used effectively to treat erectile dysfunction.3 It may also increase the hypoglycemic effects of insulin and sulfonylureas as well as reduce insulin resistance in type II diabetic patients4 and enhance immune response.5,6
Data from an epidemiologic study showed that ginseng improved survival and quality of life in breast cancer patients.7 Also, consumption of a ginseng extract was associated with a reduction in the incidence of all cancers in case-controlled epidemiologic studies.8,9
Because ginseng showed estrogenic activity in vitro,10 patients with hormone-sensitive cancers should avoid taking it until definitive clinical data become available.
Adverse Effects
Dry mouth, tachycardia, nausea, vomiting, diarrhea, insomnia, and nervousness have been reported following use of ginseng.1
A 26-year-old male without a history of mental illness became manic after chronic consumption of P ginseng capsules. His symptoms, including irritability, insomnia, flight of ideas, and rapid speech, resolved following discontinuation of the supplement.11
Gynecomastia has been reported in a 12-year-old boy after ingesting ginseng extract for bodybuilding.12
Herb-Drug Interactions
Insulin and sulfonylureas: P ginseng can increase the hypoglycemic effects of insulin and sulfonylureas.4
Anticoagulants: P ginseng may antagonize the effects of anticoagulants.13
Imatinib: In combination with imatinib (Gleevec), P ginseng may increase the risk of hepatotoxicity.14
Raltegravir: Elevated plasma levels of raltegravir (Isentress), an antiretroviral drug, were reported in a patient following concurrent use of raltegravir and ginseng.15 ■
References
1. Attele AS, Wu JA, Yuan CS: Ginseng pharmacology: Multiple constituents and multiple actions. Biochem Pharmacol 58:1685-1693, 1999.
2. He BC, Gao JL, Luo X, et al: Ginsenoside Rg3 inhibits colorectal tumor growth through the down-regulation of Wnt/ß-catenin signaling. Int J Oncol 38:437-445, 2011.
3. de Andrade E, de Mesquita AA, Claro Jde A, et al: Study of the efficacy of Korean Red Ginseng in the treatment of erectile dysfunction. Asian J Androl 9:241-244, 2007.
4. Ma SW, Benzie IF, Chu TT, et al: Effect of Panax ginseng supplementation on biomarkers of glucose tolerance, antioxidant status and oxidative stress in type 2 diabetic subjects: Results of a placebo-controlled human intervention trial. Diabetes Obes Metab 10:1125-1127, 2008.
5. Cho YK, Sung H, Lee HJ, et al: Long-term intake of Korean red ginseng in HIV-1-infected patients: Development of resistance mutation to zidovudine is delayed. Int Immunopharmacol 1:1295-305, 2001.
6. Scaglione F, Cattaneo G, Alessandria M, et al: Efficacy and safety of the standardized ginseng extract G115 for potentiating vaccination against common cold and-or influenza syndrome. Drugs Exp Clin Res 22:65-72, 1996.
7. Cui Y, Shu XO, Gao YT, et al: Association of ginseng use with survival and quality of life among breast cancer patients. Am J Epidemiol 163:645-653, 2006.
8. Shin HR, Kim JY, Yun TK, et al: The cancer-preventive potential of Panax ginseng: A review of human and experimental evidence. Cancer Causes Control 11:565-576, 2000.
9. Yun TK, Choi SY: Non-organ specific cancer prevention of ginseng: A prospective study in Korea. Int J Epidemiol 27:359-364, 1998.
10. Lee Y, Jin Y, Lim W, et al: A ginsenoside-Rh1, a component of ginseng saponin, activates estrogen receptor in human breast carcinoma MCF-7 cells. J Steroid Biochem Mol Biol 84:463-468, 2003.
11. Engelberg D, McCutcheon A, Wiseman S: A case of ginseng-induced mania. J Clin Psychopharmacol 21:535-536, 2001.
12. Kakisaka Y, Ohara T, Tozawa H, et al: Panax ginseng: A newly identified cause of gynecomastia. Tohoku J Exp Med 228:143-145, 2012.
13. Lee SH, Ahn YM, Ahn SY, et al: Interaction between warfarin and Panax ginseng in ischemic stroke patients. J Altern Complement Med 14:715-721, 2008.
14. Bilgi N, Bell K, Ananthakrishnan AN, et al: Imatinib and Panax ginseng: A potential interaction resulting in liver toxicity. Ann Pharmacother 44:926-928, 2010.
15. Mateo-Carrasco H, Gálvez-Contreras MC, Fernández-Ginés FD, et al: Elevated liver enzymes resulting from an interaction between raltegravir and Panax ginseng: A case report and brief review. Drug Metabol Drug Interact 27:171-175, 2012.
The use of dietary supplements by patients with cancer has increased significantly over the past 2 decades despite insufficient evidence of safety and effectiveness. Finding reliable sources of information about dietary supplements can be daunting. Patients typically rely on
family, friends, and the Internet, often receiving misleading information.
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 ginseng for this issue because it is increasingly being used by cancer patients.
Compiled by Barrie R. Cassileth, PhD, and Jyothi Gubili, MS, Memorial Sloan-Kettering Cancer Center. The About Herbs website is managed by K. Simon Yeung, PharmD, MBA, Lac, Memorial Sloan-Kettering Cancer Center.
