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Eventos adversos e interações entre agentes antineoplásicos e fitoterapia/suplementos alimentares no tratamento do cancro da mama: revisão sistemática
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O cancro da mama representa a doença oncológica mais comum em mulheres e a segunda principal causa de morte em todo o mundo. O tratamento do cancro da mama é complexo e multidisciplinar, podendo envolver várias terapêuticas. Uma das estratégias terapêutica é a quimioterapia com recurso a agentes antineoplásicos que possuem margens terapêuticas estreitas. Perante o tratamento quimioterápico, os doentes oncológicos recorrem, cada vez mais, à administração de produtos fitoterápicos e de suplementos alimentares de forma a atenuar os sintomas da doença e reduzir os efeitos adversos causados pela medicação. Contudo, o uso destes produtos pode conduzir a eventos adversos e interações que podem comprometer a eficácia da terapêutica, colocando em risco o tratamento e a saúde do doente. Foi realizado uma revisão sistemática da literatura utilizando as bases de dados para a pesquisa de estudos clínicos em humanos publicados até junho de 2021, com o objetivo de identificar eventos adversos e interações entre agentes antineoplásicos e fitoterapia / suplementos alimentares no tratamento do cancro da mama. Da pesquisa na base de dados, resultaram um total de 797 estudos que, após a aplicação dos critérios de elegibilidade, 10 estudos foram incluídos para análise. Nestes estudos, os produtos fitoterápicos / suplementos alimentares avaliados foram xarope de Jollab, coenzima Q10, gengibre e o seu componente 6-gingerol, óleo de babaçu, Withania somnifera, plantas medicinais chinesas, ácido docosa-hexaenóico, Scutellaria barbata (BZL101) e glutamina. Relativamente aos eventos adversos relatados do uso concomitante destes com os agentes antineoplásicos foram registados náuseas, vómitos, diarreia, ligeira irritação da faringe e espasmo associado ao vómito. Os resultados dos estudos clínicos demonstram que o uso de fitoterápicos / suplementos alimentares durante o tratamento antineoplásico contra o cancro da mama foi seguro e bem tolerado por parte dos doentes. A qualidade global dos estudos clínicos é baixa e o tamanho da amostra e diversidade dos estudos individuais condiciona a força da evidência científica dos resultados obtidos, demonstrando a necessidade futura de desenvolver mais estudos clínicos sobre a existência de eventos adversos e interações aquando da suplementação com produtos de fitoterapia e suplementos alimentares na quimioterapia no cancro da mama.
Breast cancer is the most common cancer disease in women and the second leading cause of death worldwide. The treatment of breast cancer is complex and multidisciplinary, and may involve various therapies. One of the therapeutic strategies is chemotherapy using antineoplastic agents with narrow therapeutic margins. Faced with chemotherapy treatment, cancer patients are increasingly resorting to the administration of phytotherapeutic products and dietary supplements in order to attenuate the symptoms of the disease and reduce the adverse effects caused by medication. However, the use of these products may lead to adverse events and interactions that may compromise the effectiveness of therapy, putting at risk the treatment and the patient's health. A systematic literature review was conducted using the databases to search for human clinical trials published until June 2021, with the aim of identifying adverse events and interactions between antineoplastic agents and phytotherapeutic products / dietary supplements in the treatment of breast cancer. From the database search, a total of 797 studies resulted which, after applying the eligibility criteria, 10 studies were included for analysis. In these studies, the phytotherapeutic products / dietary supplements evaluated were Jollab syrup, coenzyme Q10, ginger and its component 6-gingerol, babaçu oil, Withania somnifera, chinese medicinal plants, docosahexaenoic acid, Scutellaria barbata (BZL101) and glutamine. Regarding the adverse events reported from their concomitant use with antineoplastic agents, nausea, vomiting, diarrhoea, mild pharyngeal irritation and vomit-associated spasm were recorded. The results of the clinical studies show that the use of phytotherapeutic products / dietary supplements during antineoplastic treatment for breast cancer was safe and well tolerated by patients. The overall quality of the clinical studies is low and the sample size and diversity of the individual studies condition the strength of the scientific evidence of the results obtained, demonstrating the future need to develop further clinical studies on the existence of adverse events and interactions when supplementation with phytotherapeutic products and dietary supplements in breast cancer chemotherapy.
Breast cancer is the most common cancer disease in women and the second leading cause of death worldwide. The treatment of breast cancer is complex and multidisciplinary, and may involve various therapies. One of the therapeutic strategies is chemotherapy using antineoplastic agents with narrow therapeutic margins. Faced with chemotherapy treatment, cancer patients are increasingly resorting to the administration of phytotherapeutic products and dietary supplements in order to attenuate the symptoms of the disease and reduce the adverse effects caused by medication. However, the use of these products may lead to adverse events and interactions that may compromise the effectiveness of therapy, putting at risk the treatment and the patient's health. A systematic literature review was conducted using the databases to search for human clinical trials published until June 2021, with the aim of identifying adverse events and interactions between antineoplastic agents and phytotherapeutic products / dietary supplements in the treatment of breast cancer. From the database search, a total of 797 studies resulted which, after applying the eligibility criteria, 10 studies were included for analysis. In these studies, the phytotherapeutic products / dietary supplements evaluated were Jollab syrup, coenzyme Q10, ginger and its component 6-gingerol, babaçu oil, Withania somnifera, chinese medicinal plants, docosahexaenoic acid, Scutellaria barbata (BZL101) and glutamine. Regarding the adverse events reported from their concomitant use with antineoplastic agents, nausea, vomiting, diarrhoea, mild pharyngeal irritation and vomit-associated spasm were recorded. The results of the clinical studies show that the use of phytotherapeutic products / dietary supplements during antineoplastic treatment for breast cancer was safe and well tolerated by patients. The overall quality of the clinical studies is low and the sample size and diversity of the individual studies condition the strength of the scientific evidence of the results obtained, demonstrating the future need to develop further clinical studies on the existence of adverse events and interactions when supplementation with phytotherapeutic products and dietary supplements in breast cancer chemotherapy.
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Keywords
Cancro da mama Quimioterapia Agentes antineoplásicos Fitoterapia Suplementos alimentares Eventos adversos Interações medicamentosas Breast cancer Chemotherapy Antineoplastic agents Phytotherapy Dietary supplements Adverse events Drug interactions