|
Advertisement |
|
|
||
 |
|
|||||
|
|||||
|
 |
||||||
|
||||||
|
||||||
|
Journal of Clinical Oncology, Vol 24, No 19 (July 1), 2006: pp. 3216-3217 © 2006 American Society of Clinical Oncology. DOI: 10.1200/JCO.2006.06.5110
In ReplyUC Berkeley School of Public Health, Division of Epidemiology, Berkeley, CA, Pine Street Foundation, San Anselmo, CA, and the Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
Pine Street Foundation, San Anselmo, CA
San Francisco Oncology Associates, San Francisco, CA
China Academy of Traditional Chinese Medicine, Beijing, China
Pine Street Foundation, San Anselmo, CA and the Institute of Biophysics, Chinese Academy of Sciences, Beijing, China
Pine Street Foundation, San Anselmo, CA
UC Berkeley School of Public Health, Division of Epidemiology, Berkeley, CA We thank Firenzuoli et al for their comments on our article.1 Although the correspondents correctly indicate that there are many different possible species of the genus Astragalus, in our article we do state that our investigation focused on Astragalus membranaceus (Fisch.). The Chinese herbal pharmacopeia specifies that the root of Astragalus is the part to be used2; each of the articles we analyzed used the root, identified in the original Chinese language by the name Huang Qi. Firenzuoli et al also recommend that the percentage of Astragalus content be specified. We originally intended to include dosage amounts for each ingredient of herbal formulations used in each study, but were limited by space constraints. (We can provide this information if the correspondents contact us.) Firenzuoli et al point out that in our article we should have identified which extraction method was used to prepare the herbal medicines given to patients. With the exception of the standardized extracts Ai Di injection and Astragalus single agent (for injection use) and Jin Fu Kang (for oral use), all other studies in our report used water decoctions. Firenzuoli et al point out the variety of multiherb combinations used in these studies. In our analyses (Table 1 and Figs 2-5 of our article) we do include efficacy outcomes based on subgroups of trials in which all the studies analyzed used identical Astragalus formulations (Jin Fu Kang and Ai Di injection). There are important therapeutic reasons underlying the traditional Chinese practice of using multiherb formulations, which are now being understood better through recent discoveries in botanical research. For example, one of the articles included for analysis in our study3 bolsters the host immune response upregulating4,5 and chemotherapy toxicity-reducing6 effects of Astragalus with additional herbs that directly attack tumor cells by inducing apoptosis (Oldenlandia diffusa),7 inducing tumor necrosis (Glycyrrhiza glabra),7 and inhibiting abnormal gene transcription activity (Coix lachryma).8 While Firenzuoli et al are correct in pointing out the importance of knowing which specific chemical constituents within Astragalus may explain its therapeutic benefit, the focus of our article was on the clinical application of Astragalus, alone or in combination with other herbal medicines. At least one published monograph summarizes some of these constituents,9 although a far richer body of knowledge is contained within the libraries and databases of China. Most are published in the original Chinese, and await analysis. We hope that our article might generate interest in work to confirm which active constituents within Astragalus, or combinations of active constituents from Astragalus and other herbs, provide clinical benefit. One such project is underway, a phase II study in the United States for non–small-cell lung cancer (NCT00260026 [ClinicalTrials.gov] )10 using Jin Fu Kang. Authors' Disclosures of Potential Conflicts of Interest The authors indicated no potential conflicts of interest. REFERENCES
1. McCulloch M, Cylie S, Xiao-juan S, et al: Astragalus-based Chinese herbs and platinum based chemotherapy for advanced non-small-cell lung cancer: Meta-analysis of randomized trials. J Clin Oncol 24:419-430, 2006 2. The State Pharmacopoeia Commission of P.R. China: Pharmacopoeia of the People's Republic of China. Beijing, Chemical Industry Press, 2005 3. Liu SS: Clinical research of Fei Yi Liu He Ji in the treatment of primary bronchopulmonary cancer. Shan Dong Zhong Yi Yao Da Xue Xue Bao 28:99-102, 2004 4. Mills S, Bone K: Principles and Practice of Phytotherapy. Edinburgh, Scotland, Churchill Livingstone, 2000 5. Wei H, Sun R, Xiao W, et al: Traditional Chinese medicine Astragalus reverses predominance of Th2 cytokines and their up-stream transcript factors in lung cancer patients. Oncol Rep 10:1507-1512, 2003[Medline] 6. Duan P, Wang ZM: Clinical study on effect of Astragalus in efficacy enhancing and toxicity reducing of chemotherapy in patients of malignant tumor. Zhongguo Zhong Xi Yi Jie He Za Zhi 22515-22517, 2002 7. Sadava D, Ahn J, Zhan M, et al: Effects of four Chinese herbal extracts on drug-sensitive and multidrug-resistant small-cell lung carcinoma cells. Cancer Chemother Pharmacol 49:261-266, 2002[CrossRef][Medline] 8. Hung WC, Chang HC: Methanolic extract of adlay seed suppresses COX-2 expression of human lung cancer cells via inhibition of gene transcription. J Agric Food Chem 51:7333-7337, 2003[Medline] 9. Astragalus membranaceus. monograph. Altern Med Rev 8:72-77, 2003[Medline] 10. Clinical Trials: Safety and pharmacokinetics of Jin Fu Kang in comb w/docetaxel for patients w/non-small cell lung cancer. http://clinicaltrials.gov/ct/show/NCT00260026?order=1 Related Correspondence
|
||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
|
|
|||||||||||
|
|||||||||||
|
|
Copyright © 2006 by the American Society of Clinical Oncology, Online ISSN: 1527-7755. Print ISSN: 0732-183X
|
