Coriolus Versicolor with advanced hepatocellular carcinoma

This paper is part of nmj ’s oncology special edition 2017. Read the newspaper or download the full edition here.

reference

Chay Wy, Tham Ck, ToH Hc, et al. Use of Coriolus Versicolor (Yunzhi) as therapy in patients with advanced hepatocellular carcinoma with poor liver function or which are not suitable for standard therapy. j aged complement med . 2017; 23 (8): 648-652.

objective

to evaluate the effects of coriolus versicolor (CV) on the course of illness, survival, quality of life and blood markers in people with advanced hepato cellular carcinoma.

draft

randomized, controlled study

participant

Fifteen people (14 men, 1 woman) Asian descent aged 48 to 74 with advanced hepato cellular carcinoma (HCC) were randomized in a ratio of 2: 1 to obtain CV (n = 9) or placebo (n = 6). The participants were eligible to participate if they had an inoperables HCC and liver cirrhosis (child-pugh class C) or an HCC with cirrhosis of the liver (Child-Pugh-Class A or B) and had failed or not suitable for standard chemotherapy or radiation therapy.

study parameters evaluated

median time up to progression (TTP), response rates, toxicity, quality of life (QOL), progression -free survival (PFS), overall survival (OS), correlative analysis of blood markers

Primary result measurements

Middle TTP, PFS and OS and QOL; TTP, PFS and OS were analyzed by Kaplan-Meier and the Hazard Ratio (HR) was determined by COX regression analysis.

The quality of life was measured based on the "Functional Assessment of Cancer Treatment" questionnaire for people with Hepatobilian cancer (FACT-HEP) and the "European Organization for Research and Treatment of Cancer Quality of Life Questionnaire" (Eortc QLQ-C30).

Intervention

oral administration of 2.4 g CV daily until the disease progresses or unacceptable toxicity

important knowledge

The median treatment period was 12.1 weeks for the CV group and 5.9 weeks for the placebo group. Seventy percent of the participants broke the treatment due to progressive illness or death, and no difference in the tolerance of the treatment between the groups was determined.

illness -related results

There were no statistically significant differences in the median TTP, PFS or OS if the treatment was compared with placebo:

• Middle TTP (months): 2.5 (95 % confidence interval [CI]: 1.4–5.3) vs. 4.2 (95 % KI: 0.4–4.2), with an HR of 0.7 (95 % KI: 0.16–3.05, p = 0.63).
• Medianes PFS (months): 2.5 (95 % KI: 1.4–5.3) vs. 1.1 (95 % KI: 0.4–4.2), with an HR of 0.42 (95 % KI: 0.13–1.34), p = 0.144)
• Medianes OS (months): 6.5 (95 % KI: 3.3–24.1) vs. 2.2 (95 % KI: 0.8–23.3) with an HR of 0.35 (95 % KI: 0.10–1.25), p = 0.105)
• Total response rates: 11.1 % (95 % KI: 0.3–48.2) vs. 16.7 % (95 % KI: 0.4–64.1 %)

quality of life

In the Eortc QLQ-30, the CV group reported significantly lower pain and appetite losses, differences from –38.6 (95 % KI: –65.5 to –11.8) and –39.7 (95 % KI: –64.5 to-). 15.0), or.

No other values ​​on the Eortc or Fact-Hep were statistically significantly different.

blood analyzes

Interleukin (IL) -17f and Monozyten-Chemoattractant-Protein (MCP) -1 were reduced, and the prolactin and tumor necrosis factor (TNF)--related apoptosis-inducing ligands (trail) R1 mirror were increased in the CV group at the end of the treatment. However, no statistical comparisons were reported.

alpha-fetoprotein (AFP) mirror were not different between the groups.

practice implications

The hepatocellular carcinoma (HCC) makes up more than 80 % of the primary liver tumors. Liver cancer is the sixth most common malignant disease worldwide and the second most common cancer -related cause of death. ^{1 Although the incidence of HCC in Asia and Africa is highest, the rates in North America and Europe have increased in the past three decades. Advanced, 2 and in the United States, the relative 5-year survival in liver cancer is only 17 %. 3 In addition to survival, the quality of life is an important aspect for people with HCC, since sleep disorders, depression, fatigue, malnutrition, anorexia and pain are often reported. In view of the high mortality rate in connection with HCC and the poor quality of life, the research of additional treatments is justified.}

The study provided indications that CV can improve appetite and pain values, and this should be further evaluated in a larger population.

mushroom extract including coriolus versicolor are often used in integrative oncology as a supplement to conventional treatment. ^{4 Coriolus versicolor (also known as turkey tail, trameten versicolor and yun-zhi) Polysaccharides, especially polysaccharopeptide Krestin (PSK) and Polysaccharopeptide (PSP), which are largely responsible for its medical benefits. used. 6 coriolus versicolor is most frequently administered as a PSK standardized extract and has been examined on its effect in various types of cancer, including lung, stomach, breast and intestinal cancer, with a benefit for various results, including OS, immune function, performance status and tumor-related Symptoms. 6.7}

This current paper is the first to evaluate the effects of coriolus versicolor in people with advanced HCC. Due to the low sample size and the general lack of statistically significant results, only a few conclusive information can be found in this paper. The study provided evidence that CV can improve appetite and pain values, and this should be further evaluated in a larger population. In view of the statistically not significant improvements in the OS, PFS and QOL results, the paper generates hypotheses for future research. A larger study with sufficient power to prove clinically significant changes is justified.

In view of the supportive evidence Coriolus Versicolor in other types of cancer and the proven security profile of this mushroom, it is not unreasonable for clinicians to consider it for patients with HCC. However, there is another mushroom extract that has shown superior results especially for HCC.

Active Hexose Correlated Compound (AHCC) is a mushroom extract from the Basidiomycota division of mushrooms that was examined at HCC with promising results. A prospective cohort study with 269 patients evaluated the time until the illness and the OS for people with advanced HCC after liver resection. Hundred -trimmed patients received 3 g AHCC a day; Compared to the controls, the AHCC group had a longer recurrence-free survival (HR: 0.639, p = 0.0277) and an improved OS (HR: 0.42, p = 0.0009).

A second, smaller prospective cohort study administered 34 patients with inoperable advanced HCC who only received supporting treatment, 6 g AHCC daily and compared them with 10 placebo controls. ^{9 The median survival time was 3.5 months in the AHCC group vs. 1.5 months in the control group ( p = 0.000). In addition, the albumin and lymphocyte numbers in the AHCC group were statistically significantly improved compared to the controls.}

In view of the current knowledge,

AHCC is probably the better mushroom extract that should be considered for people with HCC. The present paper on Coriolus Versicolor is hypothesentizing, and larger studies are justified to determine whether Koriolus can improve the quality of life and survival in people with HCC.

restrictions

The greatest restriction of the study is its small sample size; The study was not enough to recognize significant changes between the groups.

The Baseline characteristics were different between CV and placebo arms; However, no statistical comparisons were presented, so that the significance is unclear. The treatment arm had a larger number of participants with prior liver resection, chemotherapy and radiation therapy. This can affect the observed differences between the study arms.

Finally, the methodology of the paper was incomplete in some areas, which made it difficult to replicate the study and endanger the external and internal validity of the results. For example, the study setting and the selection of patients were not well described, details of the treatment, including the standardization and extraction method, were not mentioned, and there was no description of the placebos or the blindness, which could lead to distortions.