Gut microbiota modulation through Traditional Chinese Medicine (TCM) - improving outcomes in Gastrointestinal (GI) cancer prevention and management

Introduction

Gastrointestinal (GI) cancers, such as colorectal cancer, pancreatic cancer and gastric malignancies, are increasing in prevalence and are notorious for poor prognosis and lack of satisfactory curative therapies. Emerging evidence indicates that the trillions of gut microbiotas in the GI tract play a crucial role in maintaining health and preventing disease, making it a promising target in GI cancer management. Additionally, the longstanding tradition and wisdom of Traditional Chinese medicine (TCM) are appreciated for offering valuable insights to complement current therapies against GI cancers. According to TCM principles, GI disorders are primarily attributed to ‘Qi-deficiency’ and disharmony among organs functions and Yin-yang imbalance. Treatment strategies not only include herbal formulations but also encompass non-pharmacological methods. For instance, well-known remedies such as Gegan Qing Lian Decoctions and Aidi injection have a long-standing history of treating GI disorders. These herbal combinations are considered Qi tonics which address the root causes of GI cancer. Furthermore, Reishi Mushroom and Ginseng are for their immune-supportive properties and ability to enhance overall vitality. Turmeric and Chinese rhubarb are noted for their anti-inflammatory, detoxifying and blood-nourishing effects. TCM also incorporates non-pharmacological interventions such as acupuncture and moxibustion, which may yield synergistic effects. The therapeutic benefits of these approaches, coupled with their symptom-relieving abilities, have provided insights for the potential integration with conventional treatments such as immunotherapy and chemotherapy. Several clinical trials have demonstrated positive outcomes, highlighting the involvement of gut microbiota in mediating the effects of these herbal interventions within the GI environment.

Methods

A comprehensive literature search was conducted using keywords including Traditional Chinese medicines (TCMs), Gastrointestinal (GI) cancers, gut microbiota, dysbiosis, GI disorders. Initially, a total of 300 articles published up to 2024 were identified, of which 180 articles were selected for inclusion in this review based on their relevance to TCM interventions and the modulation of gut microbiota in relation to GI cancer, either directly or indirectly. A variety of study designs including meta-analyses, systematic reviews, randomized controlled trials, and studies conducted on both human and rats are included.

Results

This review highlights the functions of gut microbiota and the implications of microbial dysbiosis in GI carcinogenesis, specifically focusing on the mechanisms that link disruptions in gut microbial communities to cancer progression. Additionally, it highlights the potential integration of Traditional Chinese Medicine into conventional cancer treatment and management by both pharmacological and non-pharmacological approaches.

Discussion

The review discusses the potential of TCM-based interventions to modulate the microbiome and mitigate GI cancer, along with the mechanisms through which TCM interacts with gut microbiota. Furthermore, it highlights the necessity for innovative microbiome-based approaches in GI cancer management. In conclusion, there is a critical need for more effective microbiome-based strategies that incorporate TCM, highlighting the future direction of clinical trials aimed at exploring more possibilities of involving TCM to GI cancer treatments. While conventional treatments such as chemotherapy and immunotherapy remain important, the integration of TCM may serve as complementary strategies in GI therapy. To advance the understanding of TCM-microbiome interactions, high-quality, placebo-controlled, randomized, double-blind clinical trials should be conducted.