Medicinal Plants for Chemotherapy-Induced Nausea and Vomiting: A Systematic Review of Antiemetic, Chemosensitizing, and Immunomodulatory Mechanisms.

IF 2.8 3区医学 Q1 Pharmacology, Toxicology and Pharmaceutics

Therapeutics and Clinical Risk Management Pub Date : 2025-07-31 eCollection Date: 2025-01-01 DOI:10.2147/TCRM.S531645

Xue Sun, Fangfang Nie, Jizhuo Sun, Jingdong Zhang, Yuanhe Wang

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Abstract

Background: Chemotherapy-induced nausea and vomiting (CINV) is a major burden for cancer patients, often poorly managed by conventional antiemetics, prompting exploration of medicinal plant therapies for better supportive care.

Objective: This systematic review critically evaluates medicinal plants for CINV, detailing bioactive compounds, diverse antiemetic mechanisms, and promising chemosensitizing and immunomodulatory properties.

Methods: A comprehensive literature search and critical analysis of studies investigating medicinal plants for CINV were performed.

Key findings: This review synthesizes evidence for 22 botanicals. Ginger (gingerols, shogaols) acts via 5-hydroxytryptamine 3 (5-HT₃) receptor antagonism and substance P/neurokinin-1 (NK-1) inhibition, and offers chemosensitization by downregulating P-glycoprotein. Cannabis (THC, CBD) modulates the endocannabinoid system and 5-HT₃ receptors for CINV relief and may enhance chemotherapy sensitivity. Mint (menthol, menthone) relaxes gastrointestinal smooth muscle and offers anti-inflammatory benefits. Chamomile (apigenin) has antispasmodic/anxiolytic effects; its apigenin also sensitizes cancer cells to chemotherapy. Turmeric (curcumin) acts on neurotransmitter systems, offers potent anti-inflammatory/antioxidant effects, and boosts chemosensitivity via NF-κB/P-gp modulation. Plants like Pinellia ternata, lemon, fennel, and licorice show varied mechanisms (gastrointestinal regulation, anti-inflammatory, neurotransmitter modulation). Many botanicals show chemosensitizing (inhibiting efflux pumps, promoting apoptosis) and immunomodulatory (affecting cytokines, immune cells) properties. Synergistic plant combinations (eg, ginger with P. ternata or turmeric) are noted for enhanced efficacy and safety.

Conclusion: Medicinal plants offer a compelling, multi-targeted approach for CINV management, with potential beyond symptomatic relief via their antiemetic, chemosensitizing, and immunomodulatory actions. Rigorous clinical trials are needed to integrate these botanicals into evidence-based supportive cancer care.

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化疗引起的恶心和呕吐的药用植物：止吐、化学致敏和免疫调节机制的系统综述。

背景：化疗引起的恶心和呕吐（CINV）是癌症患者的主要负担，通常传统的止吐药管理不善，促使探索药用植物疗法以获得更好的支持治疗。目的：本综述对CINV的药用植物进行了系统评价，详细介绍了其生物活性化合物、多种止吐机制以及有希望的化学致敏和免疫调节特性。方法：对研究CINV的药用植物进行综合文献检索和批判性分析。主要发现：本综述综合了22种植物药的证据。姜（gingerols, shogaols）通过5-羟色胺3 （5-HT₃）受体拮抗剂和P/神经激肽-1 （NK-1）抑制作用，并通过下调P-糖蛋白提供化学致敏作用。大麻（THC， CBD）调节内源性大麻素系统和5-HT₃受体来缓解CINV，并可能提高化疗的敏感性。薄荷（薄荷醇，薄荷酮）可以放松胃肠道平滑肌，并具有抗炎作用。洋甘菊（芹菜素）具有抗痉挛/抗焦虑作用；它的芹菜素还能使癌细胞对化疗敏感。姜黄（姜黄素）作用于神经递质系统，具有有效的抗炎/抗氧化作用，并通过NF-κB/P-gp调节提高化学敏感性。像半夏、柠檬、茴香和甘草这样的植物表现出不同的机制（胃肠道调节、抗炎、神经递质调节）。许多植物药具有化学致敏（抑制外排泵，促进细胞凋亡）和免疫调节（影响细胞因子，免疫细胞）特性。协同植物组合（例如，生姜与黄姜或姜黄）以提高功效和安全性而闻名。结论：药用植物为CINV的治疗提供了一种令人信服的、多靶点的方法，除了通过其止吐、化学致敏和免疫调节作用缓解症状外，还具有潜在的潜力。需要进行严格的临床试验，将这些植物药物纳入循证支持性癌症治疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Therapeutics and Clinical Risk Management HEALTH CARE SCIENCES & SERVICES-

CiteScore

5.30

自引率

3.60%

发文量

139

审稿时长

16 weeks

期刊介绍： Therapeutics and Clinical Risk Management is an international, peer-reviewed journal of clinical therapeutics and risk management, focusing on concise rapid reporting of clinical studies in all therapeutic areas, outcomes, safety, and programs for the effective, safe, and sustained use of medicines, therapeutic and surgical interventions in all clinical areas. The journal welcomes submissions covering original research, clinical and epidemiological studies, reviews, guidelines, expert opinion and commentary. The journal will consider case reports but only if they make a valuable and original contribution to the literature. As of 18th March 2019, Therapeutics and Clinical Risk Management will no longer consider meta-analyses for publication. The journal does not accept study protocols, animal-based or cell line-based studies.