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Astragalus membranaceus root is similar to cloves, with a long track record in chinese herbal medicines in a supporting role to western oncology. Given as both herbal supplements and injectable forms, with equal effect. Meta-analyses run on large numbers of clinical trials shows consistent improvements in response rates – a combination of complete plus partial responses and risk reduction ratios.
In colorectal cancer, Canadian research reports on average 35% risk reductions in patients adding astragalus. Higher in years one and two but still 14% after three years. Similarly 1 and 2 year response rates with oxaliplatin chemotherapy in advanced stage gastric cancer over 40% at 1 year, larger at 2 years (see Examples). Almost identical outcomes are shown in advanced cervical and breast cancer studies (see References)
In line with these research findings are results in recent clinical trials for advanced lung cancer treatment in Turkey. Used with chemotherapy drugs, including tyrosine kinase inhibitor erlotinib, astragalus was added to explore herbal alternatives to immunotherapy drugs with surprisingly good effects. On average, patients who took astragalus for at least 6 months halved the relative progression risk. Across large amounts of data including this trial, astragalus consistently supports reduced drug side effects, including neutropenia, anemia, thrombocytopenia, nausea, diarrhea and neurotoxicity.
Crucially, immune system inflammation is a well proven driver of metastatic activity, and there is evidence astragalus reduces this inflammatory activity (click on icon for references). In lung cancer, astraglaus has been reported to improve neutrophil-to-lymphocyte ratios in lung cancer patients by about a third. Reduced NLR levels are linked to lower overall risks especially when lower NLR can be sustained over a longer time period, and in this patient data the risk reduction is over 75%. As with danshen, these publications also call for more rigorous clinical trials to repeat these results in western oncology settings.
Our data also showed that AMe increases OS despite different types of regimens, though this may be because near all of our patients used cisplatin doublets. As with CT, Astragalus and epidermal growth factor receptor (EGFR) tyrosine kinase inhibitor have an additive effect on EGFR mutant lung cancer, according to current literature.[19,20] Consistent with these data, our results showed survival advantages of AMe in combination with erlotinib or CT. Although our population is relatively low, i...
Our findings should be of interest to cancer researchers and funding agencies. We found consistent evidence of improved survival and tumor response in astragalus-based herbal medi-cine therapy combined with platinum-based chemotherapy compared with platinum-based chemotherapy alone, the standard of care. While there is reason to be cautious of the quality of the included clinical trials, due to their small sample sizes and inadequate reporting of methodological issues, there has been a consi...
..compared with patients treated with PBC [chemotherapy] alone, those treated with Astragalus had a better ORR (RR: 1.24) [meaning both complete plus partial responses], DCR (RR: 1.10) [disease control], 1-year survival rate (RR: 1.41), 2-year survival rate (RR: 3.13), and QOL (RR: 2.03); higher proportions of CD3+ T cells and CD3+ CD4+ T cells; higher ratio of CD4+/CD8+ T cells; nature killer cells; and lower incidence of ADRs [ad...
A total of 19 [cervical cancer] trials were included in the analysis. Compared with the control group, the Astragalus-combined with CT [chemotherapy] group showed a significantly increased tumor response (complete and partial response (CR and PR)) …This group also displayed remarkably reduced CT toxicity [side effects] …Our study suggests that Astragalus-containing CHM might be a potential option for cervical cancer to enhance the curative efficacy and reduce CT toxicity.
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| https://onkoloji.dergisi.org/pdf/pdf_TOD_1209.pdf | 5 | .. analysis showed that OS [overall survival] was significantly longer in Group A [oral doses of astragalus] than Group C (21±4.2 vs. 11±0.9 months)...The multivariate analysis showed that only astragalus (hazard ratio [HR]: 0.46 [i.e54% risk reduction]) and erlotinib (HR: 0.45) usage were correlated with significantly longer OS [Overall Survival] | Astragalus-based traditional Chinese medicine may have a potential clinical efficacy in the treatment of advanced NSCLC. More rationally designed trials are needed to investigate tumor response, survival, and quality of life of NSCLC patients using AMe. Astragalus extract may consider as a supportive care agent in metastatic NSCLC patients. |  |
| https://www.researchgate.net/publication/288149228_Astragalus-containing_Chinese_herbal_combinations_for_advanced_non-small-cell_lung_cancer_A_meta-analysis_of_65_clinical_trials_enrolling_4751_patients | 5 | Our findings should be of interest to cancer researchers and funding agencies. We found consistent evidence of improved survival and tumor response in astragalus-based herbal medi-cine therapy combined with platinum-based chemotherapy compared with platinum-based chemotherapy alone, the standard of care | We found a large treatment effect of adding astragalus-based herbal treatment to standard chemotherapy regimens. There is a pressing need for validation of these findings in well-conducted RCTs in a Western setting. | |
| https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.632168/full | 5 | Six trials reported the survival rate , Additionally, in two trials the survival rate was extracted from survival curves. Thus, eight trials containing 512 cases were included. The results demonstrated that there was no significant difference in the half-year survival rate between the two groups [oxalipatin vs cisplatin chemotherapy] (RR: 1.14) However, compared with the PBC-treated control group, the 1- and 2-year survival rates in the Astragalus-based TCM group were significantly improved (RR: 1.41) [complete + partial response rates] and RR: 3.13) | Astragalus-containing TCM plus PBC significantly reduced the risk of neutropenia (RR: 0.65), anemia (RR: 0.68) thrombocytopenia (RR: 0.65), nausea and vomiting (RR: 0.73), diarrhea (RR: 0.58), hepatic dysfunction (RR: 0.55), renal dysfunction (RR: 0.48), neurotoxicity (RR: 0.78), and alopecia (RR: 0.77), but not the stomatitis rate (RR: 0.73) | |
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8361476/ | 5 | A total of 19 [cervical cancer] trials were included in the analysis. Compared with the control group, the Astragalus-combined with CT [chemotherapy] group showed a significantly increased tumor response (complete and partial response (CR and PR)) ...This group also displayed remarkably reduced CT toxicity [side effects] ...Our study suggests that Astragalus-containing CHM might be a potential option for cervical cancer to enhance the curative efficacy and reduce CT toxicity. | The results of the meta-analysis show that tumor response significantly improves with Astragalus-containing CHM combined with CT. According to previous reports, the aqueous extract of Astragalus membranaceus has been shown to induce apoptosis of H22 tumor cells and inhibit tumor growth (Li et al., 2012). Polysaccharides from Astragalus membranaceus show potent immunomodulatory activity by stimulating macrophages and increasing the level of cytokines, including the tumor necrosis factor-alpha (TNF-α) and granulocyte-macrophage colony-stimulating factor | |
| https://pmc.ncbi.nlm.nih.gov/articles/PMC6700271/ | 5 | This meta-analysis indicated that the combination of Astragalus-based Chinese medicines and chemotherapy may increase the efficiency of tumor response rate (TRR) for the treatment of CRC patients (RR: 1.52) [complete plus partial response rates >50% higher], improve their life quality based on KPS (RR: 2.51) [response rates], and reduce [by about half] the adverse reactions, including neutropenia , anemia, thrombocytopenia , nausea and vomiting , diarrhea, and neurotoxicity | Astragalus, also known as Huangqi, which has been widely used for more than 2,000 years. Increasing data have shown that it has the potential of anticancer, including increasing the sensitivity of antitumor drugs... In addition, many clinical studies have also shown that Astragalus, had outstanding anticancer activity (5, 25, 29). Based on experimental and clinical evidences, we believe that Astragalus-based Chinese medicines combined with chemotherapy can significantly improve TRR in patients with CRC, which is consistent with our results | |
| https://pubmed.ncbi.nlm.nih.gov/27330356/ | 4.5 | Compared with platinum-based chemotherapy alone [in lung cancer], the addition of Astragalus to chemotherapy was associated with significantly increased overall survival (HR: 0.61)[meaning 39% relative risk reduction from hazard ratio] 1-year (RR: 0.73) 2-year (RR: 0.33) and 3-year survival rates (RR: 0.30) ...and tumour overall response rate (RR: 0.79) | The present study reviewed seventeen clinical trials reported in full-text publication and comprising 1552 patients. The combination of an Astragalus-based product and chemo- therapy was associated with significant increases in os, 1-year sr, 2-year sr, 3-year sr, ps, and tumour orr. Notably, side effects including anemia, neutropenia, thrombocytopenia, fatigue, poor appetite, nausea, and vomiting were signifi- cantly more frequent with platinum-based chemotherapy alone than with the combination of an Astragalus-based product and chemotherapy. | |
| https://ascopubs.org/doi/10.1200/JCO.2005.03.6392 | 4.5 | Astragalus-based Chinese herbal medicine may increase effectiveness of platinum-based chemotherapy when combined with chemotherapy. These results require confirmation with rigorously controlled trials. | Twelve studies (n = 940 patients) reported reduced risk of death at 12 months (risk ratio [RR] = 0.67; 95% CI, 0.52 to 0.87). Thirty studies (n = 2,472) reported improved tumor response data (RR = 1.34; 95% CI, 1.24 to 1.46). In subgroup analyses..reduced risk of death at 24 months (RR = 0.58) and in three studies increased tumor response (RR = 1.76) | |
| https://journals.sagepub.com/doi/10.1177/1934578X241276966 | 4.5 | A total of 4613 patients were enrolled in all included trials. Results obtained indicated that AGI significantly enhanced the sensitivity of cancers to chemo-drugs with pooled RRs (95% CI) of 1.25 (1.18, 1.32), prolonged the 1-year survival rate of patients with pooled RRs (95% CI) of 1.34 (1.14, 1.57), improved the quality of life with pooled RRs (95% CI) of 1.61 (1.34, 1.93). Similarly, Astragalus's main component, astragaloside polysaccharides (APS), also enhances drug sensitivity in clinical cancer patients. | AGI and APS Enhanced 1-Year Survival Rate Moreover, the effect of chemo-therapeutics on cancer patients could also be assessed by survival rate; hence, 1-year survival events from 8 studies were calculated as pooled RRs of 1.34 (1.14, 1.57) (Figure 5A), implying that combination treatment significantly prolonged survival compared to chemo-drugs alone. Therefore, these results revealed that AGI might increase the sensitivity of cancer patients to chemo-drugs | |
| https://pmc.ncbi.nlm.nih.gov/articles/PMC4876224/ | 4.5 | The purpose of this study is to evaluate the efficacy of CHM combined with chemotherapy for breast cancer. The study results showed that CHM combined with chemotherapy significantly increased tumor response and KPS as compared to using chemotherapy alone (RR = 1.36). Besides, CHM as an adjunctive therapy significantly reduced the nausea and vomiting at toxicity grade of III–IV (RR = 0.37), the combined therapy significantly prevented the decline of WBC in patients under chemotherapy at toxicity grade of III–IV (RR = 0.49) and prevented the decline of platelet at toxicity grade of III–IV or I–IV (RR = 0.29; 95% CI = 0.12–0.73; P = 0.008; RR = 0.77) | In the study, the pooled data has shown that CHM combined with chemotherapy significantly improved the tumor response and performance status of breast cancer patients. Also, we found that the combined therapy significantly decreases adverse events caused by chemotherapeutic interventions as compared with chemotherapy alone, including nausea and vomiting at toxicity grade of III-IV, WBC reduction at toxicity grade of III-IV, and platelet reduction at toxicity grade of I–IV or III-IV (Figures 6(a), 6(b), 6(c), and 6(d)). The efficacy of CHM as an adjuvant therapy to chemotherapy for breast cancer is in line with the findings from meta-analysis of CHM combined therapy for advanced non-small-cell lung cancer, colorectal cancer, nasopharyngeal carcinoma, and hepatocellular carcinoma, which suggest that chemotherapy combined with CHM has an advantage in various cancers | |
| https://pmc.ncbi.nlm.nih.gov/articles/PMC4900839/ | 4.5 | Three trials (360 patients) reported 3-year srs. Using a fixed-effects model, the pooled rr for 3-year sr favoured the combination of an Astragalus-based product and chemotherapy over chemotherapy alone (rr: 0.30)... The combination of an Astragalus-based product and chemotherapy was associated with significant increases in os, 1-year sr, 2-year sr, 3-year sr, ps, and tumour orr. Notably, side effects including anemia, neutropenia, thrombocytopenia, fatigue, poor appetite, nausea, and vomiting were significantly more frequent with platinum-based chemotherapy alone than with the combination of an Astragalus-based product and chemotherapy. | Our meta-analysis demonstrates the potential clinical efficacy of Astragalus-based tcm combined with platinum-based chemotherapy in the treatment of advanced nsclc. Treatment based on syndrome differentiation is a characteristic of tcm diagnosis and treatment. Herbal formulae prescribed by syndrome differentiation can be different for each patient, as is typical of tcm. In the tcm system, patients are prescribed botanicals based on specific individual variations. Chinese patent medicines and injections generally consist of extracted and condensed elements of herbs in the form of pills, capsules, electuaries, or injectable liquids | |
| https://pmc.ncbi.nlm.nih.gov/articles/PMC3585199/ | 4 | 24 trials were included for analysis. A sum of 2,109 patients was enrolled in these studies, at which 1,064 patients participated in CT combined CHM [chinese herbal medicine) and 1,039 in CT . Compared to using CT alone, CHM combined with CT significantly increase one-year survival rate (RR = 1.36)..the combined therapy significantly increased immediate tumor response (RR = 1.36) and improved Karnofsky performance score [measure of treatment efficacy] (RR = 2.90). Combined therapy remarkably reduced the nausea and vomiting at toxicity grade of III–IV (RR = 0.24) and prevented the decline of hemoglobin and platelet in patients under CT at toxicity grade of I–IV (RR = 0.64). | CTC therapy was associated with a significant increase in the number of patients who reported complete or partial response (RR = 1.36, 95% CI = 1.19–1.56, p<1.0E−5, 18 studies, 1,623 patients) [16], [18]–[34]. In addition, the advantage of CTC therapy was found in the number of patients who reported complete, partial and stable response (RR = 1.14, 95% CI = 1.08–1.19, p<1.0E-5, 19 studies, 1,697 patients, figure not showed). | |
| https://lcm.amegroups.org/article/view/5222/html | 3.5 | In the view of these facts, and having seen the impressive effect of Astragalus by modulating the immune system in cancer, we are convinced that by combining these two strategies in immunotherapy—the new one and the old one—we can definitely overcome immune cell exhaustion, boost the response to immunocheckpoint treatment, and minimize side effects, to get better and more efficient results in cancer care. | Different studies have verified that the ICP activity depends on the positive activity of CD8, together with a limited activation of regulatory T cells (TReg) (76,77). This fact seems crucial to predict good response to this treatment (78). As we have seen, some botanicals (79) and more specifically the root of Astragalus can modulate the immune microenvironment to align it in a synergistic action together with the IPC, for the sake of a longer and more lasting response to immunotherapy. | |
| https://www.frontiersin.org/journals/pharmacology/articles/10.3389/fphar.2021.737674/full | 3.5 | Our research systematically reviewed a wide range of clinical trials and laboratory studies, elucidating the potential plausibility of using APS in activating adoptive immunotherapy, as an immunological adjuvant in the future. We found that APS could play a positive part in the immune checkpoint inhibitory signaling pathways by activating the immune-suppressed microenvironment with regulated cytokines, TLR4, NF-κB, and MAPK pathways and immune cells such as macrophages, NK cells, DCs, and so on. Also, this review contributes to an understanding of APS as an adjunctive therapy to ICIs by optimizing the immunity balance in the TME and primarily elucidates the underlying mechanism of APS on the microenvironment and immunotherapy systematically. | Many studies have suggested that APS could increase the expression of CD40, CD80, and HLA-DR on the surface of DCs (Peng and Luhang, 2006). It could increase the DCs and DC-CIK cells proliferation. APS-treated DCs have the most typical structures and phenotypic markers of DCs (CD86 and HLA-DR). Liu et al. found that APS increased the amount of IFN-α, TNF-α, and IL-6 generated by pDC and promoted the differentiation of pDC (Chen et al., 2009). These results suggested that APS can enhance human humoral and cellular immunity through the pDC pathway and can be expected to be an effective adjuvant in pDC-based immunotherapy with the effect of TLR9 on pDCs. Moreover, after being processed by APS, DC-CIK cells were more powerful than ordinary DC-CIK cells in antitumor reaction | |
| https://ascopubs.org/doi/abs/10.1200/JCO.2023.41.16_suppl.537 | 3.5 | PG2 combined with adjuvant EC significantly improved adjuvant EC-induced fatigue in premenopausal BC patients. PG2 assists these patients with maintaining normal daily life and job activities, also less need of family support during chemotherapy. Furthermore, patients treated with PG2 might have better compliance to complete the whole course of adjuvant chemotherapy | Astragalus Polysaccharides (PG2) had been proved to relieve cancer-related fatigue in advanced BC patients. The aim of this study is to evaluate the efficacy of PG2 as a complementary treatment among stage II/III BC patients with adjuvant chemotherapy of epirubicin-cyclophosphamide(EC) regimen in reduction of chemotherapy-induced toxicity and encouraging compliance with chemotherapy | |
| https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2021.632168/full | 3.5 | Our study demonstrated the potencies of Astragalus-containing TCM with PBC to enhance the efficacy and safety for patients with AGC, and more efforts are needed to promote the application of Astragalus-containing TCM in the clinic. Furthermore, the long-term efficacy of Astragalus-containing TCM plus PBC in AGC treatment still needs to be verified in future well-designed clinical trials that adhere to CONSORT guidelines. | ..compared with patients treated with PBC [chemo] alone, those treated with Astragalus-containing had a better ORR [response rate] (RR: 1.24), DCR [Disease control rate] (RR: 1.10), 1-year survival rate (RR: 1.41), 2-year survival rate (RR: 3.13) and QOL Quality of Lfe (RR: 2.03) ..higher proportions of CD3+ T cells and CD3+ CD4+ T cells; higher ratio of CD4+/CD8+ T cells; natural killer cells; and lower incidence of ADRs. | |
| https://www.mdpi.com/1424-8247/17/5/636 | 3.5 | ..thus, they have become increasingly important in cancer immunotherapy. APS can limit the spread of cancer by influencing immune cells, promoting cell death, triggering cancer cell autophagy, and impacting the tumor microenvironment. When used in combination with other therapies, APS can enhance treatment outcomes and reduce toxicity and side effects. APS combined with immune checkpoint inhibitors, relay cellular immunotherapy, and cancer vaccines have broadened the application of cancer immunotherapy and enhanced treatment effectiveness. | This review comprehensively evaluates the anticancer mechanisms of APS, focusing on its potential use in cancer immunotherapy. The results underscore the ability of APS to activate and modulate immune cells, disrupt the cell cycle, induce cancer cell apoptosis, trigger cellular autophagy, and regulate signal transduction pathways, especially showing potential in enhancing the sensitivity of antitumor therapy, attenuating the treatment-related side effects, and reversing drug resistance | |
| https://journals.sagepub.com/doi/full/10.1177/1934578X241276966 | 3.5 | Fifty-one studies were included for meta-analysis following a thorough screening process that adhered to the inclusion and exclusion criteria. A total of 4613 patients were enrolled in all included trials. Results obtained indicated that AGI significantly enhanced the sensitivity of cancers to chemo-drugs with pooled RRs (95% CI) of 1.25 (1.18, 1.32), prolonged the 1-year survival rate of patients with pooled RRs (95% CI) of 1.34 (1.14, 1.57), improved the quality of life with pooled RRs (95% CI) of 1.61 (1.34, 1.93). Similarly, Astragalus's main component, astragaloside polysaccharides (APS), also enhances drug sensitivity in clinical cancer patients | Astragalus significantly enhanced the chemosensitivity of cancer patients. However, there is still no systematically conclusive data revealing the function of a single AGI in improving chemosensitivity in various cancer patients.84–87 Additionally, one systematic analysis showed that AGI significantly enhanced chemosensitivity in advanced NSCLC patients. However, it did not include other types of cancer patients.88 In our study, studies unveiling the effect of AGI injection or its main ingredient in combination with chemo-drugs in various cancer patients were extracted from the database for analysis. The pooled RRs for tumor response rate in all cancer patients were significantly over 1, especially the RRs for TR were over 1 in NSCLC, which was in line with the previous study.89 Strangely, the pooled RRs of gastric cancer were over 1, but there was no obvious significance, which implied that it could not be concluded that AGI could strengthen the sensitivity of gastric cancer patients to chemo-drugs | |
| https://journals.sagepub.com/doi/10.1177/1534735421995256 | 3.5 | Interestingly, we observed that the median baseline NLR was higher in the PG2 (astragalus) group than in the Control group (4.51 vs 2.81); however, 6 weeks after ICI treatment initiation, the median NLRs in the 2 groups were comparable (3.73). We hypothesized that a high NLR might be associated with CRF, which indicates PG2 administration. No significant difference in the median OS was observed between the 2 groups (PG2 vs Control, 26.1 months vs 25.4 months, respectively); this is notable given the significantly higher baseline NLR in the PG2 group before the ICI and PG2 treatment initiation. Therefore, we propose that in patients receiving ICI combination therapy, PG2 may decrease or stabilize the NLR, and the survival time might be similar to that of patients with low NLR. | A high NLR at 6 weeks after ICI treatment initiation was associated with a worse OS. We observed that PG2, which is used clinically to alleviate fatigue, could decrease the prognostic indicator, NLR, among patients with advanced lung cancer treated with ICI combination therapies....cancer-associated chronic inflammation is linked with neutrophilia and accompanied by relative lymphocytopenia.21 Additionally, higher blood neutrophil levels are correlated with fatigue severity after therapy,22 and PG2 significantly improves CRF by regulating chronic inflammation, which is a critical pathway in the etiology of CRF.19,23,24 PG2 treatment may have reduced inflammation and consequently, the NLR among patients in the PG2 group, who had CRF as well as elevated NLR before ICI treatment initiation. In contrast, 20% of the patients in the control group, who had no use of PG2, showed increased NLR after treatment initiation | |
| https://www.nature.com/articles/s41598-024-76627-z | 3 | The results suggest that PG2 may have additional efficacy in preventing and reducing the severity of CIF among premenopausal patients undergoing adjuvant anthracycline-based chemotherapy. PG2 could assist these patients in maintaining normal daily activities, caring for family, and managing job responsibilities during chemotherapy. Furthermore, patients undergoing cancer chemotherapy and treated with PG2 might be better positioned to complete their chemotherapy, alleviating concerns about their future health. | Overall, 66 eligible patients were equally randomized into the PG2 and placebo groups between March 01, 2018, and March 09, 2021. The mean change in the FGS and fatigue intensity did not significantly differ between both groups. However, the FGS and fatigue intensity were less aggravated in the first four cycles in the premenopausal-PG2 group than in the placebo group. Our study concluded PG2 combined with adjuvant chemotherapy can reduce CIF, insomnia, the negative effect on future perspectives, and improve global health status, especially for premenopausal patients with breast cancer | |
| https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2019.00749/full | 3 | Meanwhile, it was pleased to find that chemotherapy-related adverse reactions appeared less frequent and milder in the use of concomitant Astragalus-based Chinese medicines, which suggested Astragalus-based Chinese medicines could increase the compliance to chemotherapy and finally lead to improvement of patients KPS. Furthermore, several studies have shown that Astragalus could markedly reduced myelosuppression, gastrointestinal reaction, and neurotoxicity | ased on experimental and clinical evidences, we believe that Astragalus-based Chinese medicines combined with chemotherapy can significantly improve TRR in patients with CRC, which is consistent with our results. Chemotherapy often leads to some side effects, including myelosuppression, hepatic and renal dysfunction, gastrointestinal reaction, and neurotoxicity. In China, TCM may be combined with chemotherapy with the aim to reduce the side effects of anticancer drugs | |
| https://pmc.ncbi.nlm.nih.gov/articles/PMC8522094/ | 3 | Twenty five DEGs (15 up-regulated and 10 down-regulated) of Astragalus membranaceus treatment in HepG2 cells were identified. Among the 25 genes, MT1F, MT1G, MT1X and HMOX1 may play essential roles. Astragalus membranaceus mainly affects the Mineral absorption pathway in HCC. A total of 256 genes (p < 0.01) related to prognosis of HCC were identified, and MT1G is a common gene between prognosis genes and DEGs. Furthermore, Astragalus membranaceus may directly down-regulate MT1G through daidzein to promote ferroptosis of HCC cells and improve prognosis for HCC. | Therefore, Astragalus membranaceus is likely to treat HCC by affecting the Mineral absorption pathway. It is worth noting that the biological process of negative regulation of growth was significantly enriched (Table S2). Therefore, GSEA analysis was performed to explore the changes in the overall negative regulation of growth biological process (Fig. S3). We observed that negative regulation of growth was increased after Astragalus membranaceus treatment in HepG2 cells, suggesting that the growth of HepG2 cell line is likely to be inhibited by Astragalus membranaceus (Fig. S3). | |
| https://www.mdpi.com/2072-6694/11/8/1054 | 2.5 | This clinical study highlights the disease-relevance of changes in systemic levels of inflammatory cytokines, including IL-1β, IL-6, IL-12, GM-CSF, TGF-β1, and IFN-γ as well as the therapeutic efficacy of PG2 as a cancer symptom cluster-alleviating, QoL-improving, inflammation-limiting, adjunct therapy for patients with metastatic or advanced stage cancer. To the best of our knowledge, this is the first study providing evidence that PG2 ameliorates cancer symptom clusters, as well as improves quality of life in patients with metastatic disease, through down-modulation of the inflammatory cascade. | The resultant effect of PG2 treatment highlights the therapeutic efficacy and medical validity of inflammatory cascade blockade as an effective therapeutic approach for patients with metastatic or advanced stage disease. Combining results of our present study with those from our teams previously published work [16]; PG2 is a potential inflammation-targeting therapeutic option for managing patients with metastatic and advanced disease patients. It is noteworthy that univariate and multivariate analyses suggest a strong positive correlation between EORTC QLQ-C30-based QoL and the responsiveness of the inflammatory cytokines | |
| https://www.spandidos-publications.com/10.3892/or.2019.7062 | 1 | ..astragaloside IV [Astragalus] treatment reduced the invasive and migratory capacities of cervical cancer cells in vitro by inhibiting pP38 in the MAPK signaling pathway, and PI3K in the PI3K signaling pathway, while downregulating TGF-β1 expression. These effects led to an increased level of the EMT marker, E-cadherin. Antitumor effects of astragaloside IV treatment were observed in vivo. Taken together, astragaloside IV is a natural active ingredient with low toxicity, and its combined use with cisplatin effectively prevented tumor growth and metastasis. | However, plant extracts are affected by several factors inside the human body, including absorption, distribution, metabolism and secretion. To determine the in vivo effect of astragaloside IV treatment, tumor transplantation experiments with nude mice were performed. Tumor growth and metastasis were visualized by in vivo imaging, which demonstrated that treatment with astragaloside IV alone inhibited the metastatic ability of the cervical cancer cells. Notably, compared with the treatment with cisplatin alone, the combined use of astragaloside IV with cisplatin effectively prevented the metastasis of the cervical cancer cells | |
| https://ar.iiarjournals.org/content/37/2/465.abstract | 1 | AS-IV and curcumin demonstrated synergistic suppressive efficacy against angiogenic factors VEGF, FGF-2, MMP-2 and HGF, as well as thrombosisrelated factors TF and FVII. Up-regulation of microRNAs miR-122 and down-regulation of miR-221 may mediate antiangiogenesis mechanisms of AS-IV [Astragalus] and curcumin in HCC [Liver cancer]. This study indicates the potential for AS-IV and curcumin TCM for treatment of HCC | miR-122, as a tumorsuppressor gene, accounts for approximately 70% of the total miRNA in the liver (24) and inhibits metastasis of HCC through anti-angiogenic activity (25). miR-221 acts as an oncogene in HCC and is essential for angiogenesis by NOTCH signaling and induces proliferation and migration of endothelial cells (26). Our result suggests that up-regulation of miR-122 and down-regulation of miR-221 might be responsible for the anti-angiogenesis mechanisms of AS-IV and curcumin in HCC |  |
| https://www.imrpress.com/journal/FBL/24/3/10.2741/4738/htm | 1 | Our study also showed that AS-IV [Astragalus] promoted the cleavage of PARP, caspase-3 and caspase-9... AS-IV-induced apoptosis depends on caspase activation...our study demonstrated that AS-IV suppressed the growth of human CRC [Colorectal cancer] cells in vitro and in vivo, which may be possibly attributed to cell cycle arrest and apoptosis induction. The results suggest that AS-IV may be a promising therapeutic agent for CRC | Omi/HtrA2 is an antagonist of inhibitors of apoptosis (IAPs). It complexes with different IAPs and prevents their ability to bind caspases (34). Overexpression of Omi/HtrA2 induces apoptosis in human cells, and its down-regulation attenuates cell death (35). In the present study, we found that AS-IV increased the release of Cyt c and Omi in a dose-dependent manner, which may be contribute to the apoptosis-induction of AS-IV. Furthermore, mitochondrial apoptosis induced by Bax can be prevented by Bcl-2 via inhibiting the release of Cyt c (36). We also found that AS-IV treatment increased the ratio of Bax/Bcl-2, which further demonstrated the role of the mitochondria in AS-IV-induced apoptosis |  |
| https://onlinelibrary.wiley.com/doi/full/10.1155/2020/3415471 | 1 | Finally, based on the results of the experiment, the authors confirm that APS, the active component in A. membranaceus, can induce low doses of anti-PD-1 antibody responses in animals, and these antibodies may have immunomodulatory functions that can overcome the failure of immune cells under immune evasion by tumors. These results are an attempt to illustrate the possible role of A. membranaceus in immunomodulation from an alternative perspective and can assist in providing more research information for the development of anticancer drugs. | In the animal model, the tumor growth inhibition effect after scFv S12 treatment was approximately 48%. However, meaningful synergistic effects were not observed when scFv S12 was used as a cotreatment with ixabepilone. Moreover, this treatment caused a reduction in the number of tumor-associated macrophages in the tumor tissue. These experimental results indirectly indicate the ability of APS to induce specific antibodies associated with the immune checkpoint system and the potential benefits for improving immunity in humans. | |
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3271545/ | 1 | Astragalus significantly inhibited the growth of H22 carcinoma, with an inhibitory rate of 17.28-52.36%. FCM and immunohistochemical assay show that the cell apoptosis rate and protein expression of Bax and Bax/Bcl-2 ratio of H22 transplanted tumor in Astragalus treated group were significantly higher than the control group (P<0.05). The protein expression of Bcl-2 was significantly lower than control | alteration in the levels of Bax and Bcl-2 protein influences apoptosis[18] and the ratio between them is the key to determine the cell survival or death.[19,20] In our study, we showed the Astragalus injection induced apoptosis in H22 transplanted tumors and it was accompanied by up-regulation of Bax and the down-regulation of Bcl-2. The ratio of Bax/Bcl-2 also increased after Astragalus injection. These results indicate that imbalance of Bcl-2 family protein expression plays a critical role in this anti-tumor treatment. Astragalus injection induced apoptosis in H22 transplanted tumors by modulating Bcl-2 family proteins |  |
| https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7110762/ | 1 | However, the expression of LC3I/II, Atg7, and Atg12 decreased in the presence of AS-IV and DCP1A siRNA or TMSB4X siRNA. We also drew a mechanism map of AS-IV inducing autophagy through the Atg7/Atg12 pathway (Fig. (Fig.5e).5e). Thus, DCP1A and TMSB4X may be regarded as the targets of cervical cancer treatment. These results suggest that AS-IV could target the proteins DCP1A and TMSB4X and induce autophagy, resulting in the suppression of cervical cancer proliferation and invasion | After 12 h of treatment with AS-IV, we found that the cancer cell invasion was inhibited in the HeLa and SiHa cells (Fig. (Fig.1c).1c). LC3I/II, a protein marker of autophagy, was induced in the HeLa and SiHa cells (Fig. (Fig.1d).1d). These results showed that AS-IV inhibited the growth of cervical cancer cells, especially inhibiting the growth of HPV-16-infected human cervical cells, and inhibited xenograft tumor growth by inducing autophagy. | |
| https://www.sciencedirect.com/science/article/abs/pii/S1734114017303523?via%3Dihub | 1 | Our present study found that Astragaloside IV was a critical chemosensitizing agent for osteosarcoma treatment. Astragaloside IV suppressed cell proliferation and enhanced chemosensitivity in osteosarcoma cell lines and xenograft. C | The Fas/FasL signaling pathway is a key modulator of cancer cell apoptosis. Fas (Apo-1 or CD95), a cell surface receptor, plays an important role in apoptotic signal transmission in cancer cell types when interacts with Fas ligand (FasL, CD95L). Reduced Fas/FasL expression conducive to tumor progression. In the present study, we aimed to investigate the chemosensitive effects of Astragaloside IV in osteosarcoma in vitro and in vivo | |
| https://www.alliedacademies.org/articles/antihyperglycemic-and-antihyperlipidemic-activities-of-radix-astragali-and-panax-notoginseng-extract-in-human-participan.pdf | 1 | After 6 weeks of ANS supplementation, fasting blood glucose and glucose area under the curve (AUC) were significantly decreased by 10.1% and 12.69% (p<0.05), respectively. Triglycerides and sdLDL-C were significantly decreased by 31.06% and 19.96% (p<0.05), respectively, in the ANS group than in the placebo group. HDL-C, adiponectin, and AMPK were significantly increased by 11.78%, 22.07%, and 12.72% (p<0.05), respectively in the ANS group than in the placebo group. The above results indicate that oral supplementation with ANS reduces hyperglycemia and dyslipidemia without adverse events. | ANS helped regulate glucose and lipid metabolism by increasing adiponectin levels and activated AMPK signaling pathway and thereby reduced blood glucose and blood lipids levels with no adverse effects. Based on this pilot trial, we would like to conduct an extensive clinical trial to crosscheck the effect of ANS on hyperglycemic and hyperlipdemic subjects with or without standard antidiabetic or dyslipidemia medication as well as to explore the deep mechanism behind ANS's anti-diabetic and hypolipidemic properties | |
| https://www.mdpi.com/2072-6643/11/10/2264 | 1 | Consistent with the in vitro and ex vivo results, our in vivo studies showed that treatment with PG2 elicited significant time-dependent depletion of the tumor-associated M2 population, synergistically enhanced the anti-M2-based anticancer effect of cisplatin, and inhibited xenograft tumor growth in the NSCLC mice models. Moreover, in the presence of PG2, cisplatin-associated dyscrasia and weight-loss was markedly suppressed. Conclusion: These results do indicate a therapeutically-relevant role for PG2 in modulating the M1/M2 macrophage pool, facilitating DC maturation and synergistically enhancing the anticancer effect of conventional chemotherapeutic agent, cisplatin, thus laying the foundation for further exploration of the curative relevance of PG2 as surrogate immunotherapy and/or clinical feasibility of its use for maintenance therapy in patients with lung cancer. | Taken together, these results demonstrate, as shown in graphical abstract Figure 7, for the first time the novel role of PG2 as an effective modulator of tumoral M1/M2 macrophage polarization and a potent activator of DC maturation. These results provide some mechanistic insight into observed macrophage-mediated, PG2-induced, immune-based anticancer and chemotherapy-potentiating activity. This study thus lays the foundation for further exploration of the role of PG2 as alternative cancer immunotherapy or maintenance therapy for patients with NSCLC. |
A 2021 study in advanced stage lung cancer treatment from the Turkish national health authority. This report evaluates alternatives to high cost immunotherapy drugs in the contex of adding them to foundation treatments like chemo and targeted drugs eg TKIs. Over a hundred patients of median age 61, mostly male, took 2 or 3x 250 mg daily doses for at least 6 months during oncology treatment. The addition of astragalus to several types of chemotherapy or to erlotinib tyrosine kinase inhibitors essentially doubled patient survival times. Researchers here point to various possible anti-cancer and anti-metastatic actions identifed in pre-clinical reports as likely reasons for the significantly extended survival. Astragalus extract is now recommended by the Turkish national health authority for patients seeking to add to their first line chemotherapy or TKI treatments.
The reported OS here of 21 month is almost identical to the use of pembrolizumab AND chemotherapy for the 3/4 of “low” PDL-1 type NSCLC patient groups in this large meta analysis https://pmc.ncbi.nlm.nih.gov/articles/PMC11273333 These outcomes are also better than those available in real world clinical trials of immunotherapy drugs alone, those not sponsored by big pharma: https://www.nature.com/articles/s41598-021-85696-3/ Astragalus shows significant ability to invigorate and re-balance immune system function, reduce inflammatory responses and more. So rather than debilitating side effects, many patients here reported improved quality of life. And the report also describes reduced metastatic spread. Effects are assumed to be both due to immune system enhancing effects as well as actions in metabolic growth pathways. Patients using blood pressure medication also had some improved OS, indicating the benefits of lowering blood pressure.
A meta analysis in 2010 analyzed the impacts of Astragalus extracts in a total of 65 clinical trials in china to map overall effects. 4751 lung cancer patients received Astragalus extract alongside standard chemotherapy and oncology treatments. The study finds a 6 month decrease in risk levels of 46%, with lower but significant 35% and 26% at the one and two year time periods. For the first year of treatment, Astragalus decrease the risks of treatment failure by 35% after a year, and still at 35% after 2 years. The tumor response rates, meaning measurable improvements in tumor size, across 27 trials, were 43% higher likelihood of the most significant reductions , and also 35% higher of at least partial effects on tumor burden indicating probable overall quality of life benefits.
These trials showed much the same results, indicating consistent findings despite differing quality levels. That said, there are trials finding no effect published and included in the data, and the researchers find no evidence of bias. There results are more than those found from adding immunotherapy drugs to chemotherapy.
A 2021 meta-analysis of clinical trials in advanced gastric cancer with chemotherapy. Across 35 trials and nearly 2500 patients the combined complete+partial response rates were increased 24%, and with oxalipatin the disease control rate was 10% higher. These results are similar to to the effects obtained by adding immontherapy such as nivolumab to a first line chemotherapy treatment;
In this analysis , only 8 of these trials reported on average that relative overall survival rates were over 40%, at one year and 3X at 2 years. But that a higher number of studies was needed to make a meta-analysis result. In terms side effects , an average 40 to 50% reduction in adverse reactions including neutropenia anemia thrombocytopenia nausea and vomiting , diarrhea and neurotoxicity. That alone motivates the benefits of Astragalus.
Immune system inflammation is consistently reported to increase progression, both at pre-diagnosis and when arising during oncology. Elevated white blood cell count including neutrophils and leukocytes, are inflammatory responses proven to increase metastatic activity. Astragalus decreases this inflammation (link 1), and probably reduces risk levels seen in specific cancers below for elevated NLR.
| Summary | Source |
|---|---|
| Study of advanced lung cancer patient records during immunotherapy shows striking improvements in immune system balance. As measured by over 38% relative improved neutrophil-to-lymphocyte ratios (32% actual decrease vs 6% increase in controls) | LINK |
| This study of neutrophil-to-lymphocyte levels at diagnosis for HR+ type breast cancers reports strong association to lymph node metastatic spread. Relatively lower levels decrease this risk 2.4X. | LINK |
| This study reports 64% overall risk reduction in metastatic prostate cancer patients with lower neutrophil-to-lymphocyte ratio, and 60% slower pace of PSA elevation. Indicating lowering immune inflammatory response may slow further metastatic disease progression significantly. | LINK |
| During immunotherapy for colorectal cancer, patients with both a lower pre operative NLR and quickly re-balanced levels after surgery had much lower progression risks, about two thirds. General inflammation (CRP) had even more effect. | LINK |
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