Highlights
Different preliminary clinical trials, observational studies and meta-analyses suggest that Astragalus extract might have potential health benefits and may help reduce certain chemotherapy-induced side-effects such as nausea, vomiting, diarrhea, bone-marrow suppression, improve the quality of life of advanced cancer patients; improve cancer related fatigue and anorexia and synergize with certain chemotherapies and improve their therapeutic effectiveness, especially in non-small cell lung cancer. However, astragalus extract may interact with certain drugs including chemotherapies for cancer, leading to adverse events. Hence, random use of Astragalus supplements should be avoided.
What is Astragalus?
Astragalus is a herb that has been used in Traditional Chinese medicine for hundreds of years. It is also known as “milk vetch” or “huang qi” which means “yellow leader”, since its root is yellow in color.
Astragalus extract is known to have medicinal properties and is generally used to support a healthy immune system. There are over 3000 different species of Astragalus. However, the most commonly used species in the astragalus supplements is Astragalus membranaceus.
Health Benefits of Astragalus Extract
The root is the medicinal part of the Astragalus plant. The health benefits of Astragalus extract is attributed to the different active compounds present in the plant including:
- Polysaccharides
- Saponins
- Flavonoids
- Linoleic acid
- Amino acids
- Alkaloids
Of these, Astragalus polysaccharide is considered as the most important component with multiple pharmacological effects.
In Traditional Chinese Medicine, Astragalus extract has been used alone or in combination with others herbs for various health conditions. Following are some of the health benefits and medicinal properties claimed for Astragalus.
- May have antioxidant properties
- May have antimicrobial, antiviral and anti-inflammatory properties
- May have cardioprotective effects / help improve heart function
- May boost the Immune system / have immunomodulating effects
- May reduce chronic fatigue / improve strength and stamina
- May protect kidneys
- May help control blood sugar levels
- May have certain anticancer effects
- May reduce certain side-effects of chemotherapy
- May help in treating common cold and other allergies
Side-Effects and Possible Interactions of Astragalus with other Drugs
Although astragalus is generally considered safe, it may interfere with certain drugs and may lead to certain side-effects.
- Since Astragalus has immune boosting properties, its use along with immunosuppressant drugs such as prednisone, cyclosporine and tacrolimus may decrease or nullify the effectiveness of these drugs which are intended to suppress the immune function.
- Astragalus has diuretic effects. Hence, its usage along with other diuretic drugs may amplify their effects. Additionally, taking astragalus might also impact how the body removes lithium, thereby resulting in an increase in lithium levels and associated side-effects.
- Astragalus may also have blood thinning properties. Hence, its usage along with other anticoagulant drugs may increase the risk of bleeding.
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Studies on Astragalus Extract Use in Cancer
1. Pharyngeal or Laryngeal Cancers
Impact of Astragalus Polysaccharides along with Concurrent Chemoradiotherapy on Adverse Events and Quality of Life of Cancer Patients
In a recent, preliminary, phase II clinical trial done by the researchers of Chang Gung University in China, they studied the impact of Asparagus polysaccharides injection on concurrent chemoradiation therapy (CCRT) associated adverse events in patients with pharyngeal or laryngeal cancers. The chemotherapy regimen included cisplatin, tegafur-uracil and leucovorin. 17 patients were included in the study. (Chia-Hsun Hsieh et al, J Cancer Res Clin Oncol., 2020)
The study found that treatment-associated adverse events were less frequent in the group of cancer patients which received both astragalus polysaccharides and concurrent chemoradiation therapy (CCRT), compared to the group which received only CCRT. The study also found less quality of life variations in astragalus plus CCRT group, compared to the group which received only CCRT. The differences were significant for QOL (quality of life) factors including pain, appetite loss, and social eating behavior.
However, the study found no additional benefits on tumor response, disease-specific survival and overall survival when administered with Astragalus polysaccharides during concurrent chemoradiotherapy in the pharyngeal or laryngeal cancer patients.
2. Non-Small Cell Lung Cancer
Benefits of Astragalus injection combined with Platinum-based Chemotherapy in Cancer patients
In a meta-analysis done in 2019 by the researchers of Affiliated Hospital of Nanjing University of Chinese Medicine, China, they evaluated the benefits of using astragalus in combination with platinum-based chemotherapy in advanced non-small cell lung cancer patients. For the analysis, they obtained data through literature search in PubMed, EMBASE, China National Knowledge Infrastructure Database, the Cochrane Library, Wanfang Database, China Biological Medicine Database, and Chinese Scientific Journal Database till July 2018. The study included a total of 19 randomized controlled trials including 1635 patients. (Ailing Cao et al, Medicine (Baltimore)., 2019)
The meta-analysis found that the use of astragalus injection combined with chemotherapy may synergistically improve the efficacy of platinum-based chemotherapy, and improve 1-year survival rate, decrease the incidence of leukopenia (low white blood cell count), platelet toxicity, and vomiting. However, the level of evidence was low. Well-defined large clinical trials are required to establish these findings.
A similar analysis done a decade before, which included 65 clinical trials involving 4751 patients also suggested a possible positive impact of administering astragalus along with platinum-based chemotherapy. However, the researchers did mention the need for validating those findings in well-conducted clinical trials before going ahead with any recommendations. (Jean Jacques Dugoua et al, Lung Cancer (Auckl)., 2010)
Benefits of Co-use of Astragalus-containing Chinese Herbal medicines and Radiotherapy in Cancer Patients
In a systematic review done in 2013 by the researchers of Affiliated Hospital of Nanjing University of Chinese Medicine in China, they evaluated the benefits of using Astragalus-containing Chinese herbal medicines along with radiotherapy in non-small cell lung cancer patients. The review included a total of 29 eligible studies. (Hailang He et al, Evid Based Complement Alternat Med., 2013)
The study found that the co-use of Astragalus-containing Chinese herbal medicines and radiotherapy may be beneficial for patients with non small cell lung cancer by increasing the therapeutic effectiveness and reducing the toxicity of radiotherapy. However, the researchers suggested well-designed large clinical trials to validate these findings.
Effects of Astragalus polysaccharide injection combined with Vinorelbine and Cisplatin on quality of life and survival of Cancer Patients
Researchers from the Third Affiliated Hospital of Harbin Medical University, China carried out a trial to evaluate whether Astragalus polysaccharide (APS) injection combined with vinorelbine and cisplatin (VC) improved the quality of life of patients with advanced non-small cell lung cancer (NSCLC). The study also evaluated its impact on tumor response, toxicity, and survival results based on data from a total of 136 NSCLC patients who were enrolled in the study between May 2008 to March 2010. (Li Guo et al, Med Oncol., 2012)
The objective response rate and survival time slightly improved (42.64% and 10.7 months respectively) in those patients who received Astragalus polysaccharide (APS) injection combined with vinorelbine and cisplatin (VC) compared to those who received only vinorelbine and cisplatin (36.76% and 10.2 months respectively).
The study also found that there were improvements in the overall quality of life of the patient, physical function, fatigue, nausea and vomiting, pain, and loss of appetite in NSCLC patients treated with both Astragalus polysaccharide and VC, compared with VC alone.
Impact of Astragalus-based herbal formula on pharmacokinetics of Docetaxel
Researchers from Memorial Sloan-Kettering Cancer Center, New York, US conducted a study to evaluate the impact of Astragalus-based herbal formula on the pharmacokinetics of docetaxel in patients with NSCLC. Results from the study showed that the use of Astragalus-based herbal formula did not alter the pharmacokinetics of docetaxel nor impact the survival of patients with lung cancer. (Barrie R Cassileth et al, Cancer Chemother Pharmacol., 2009)
Impact on Bone Marrow suppression after Chemotherapy
In a study done by ZHENG Zhao-peng et al. in 2013, they evaluated the impact of taking astragalus polysaccharide injection on bone marrow suppression induced by chemotherapy in lung cancer patients. The study included a total of 61 patients with advanced non-small cell lung cancer. (ZHENG Zhao-peng et al, Chin. Herbal Med., 2013)
The study found that the incidence of bone marrow suppression in patients who received astragalus polysaccharide injection along with chemotherapy was 31.3%, which was significantly lower than 58.6% in those who received chemotherapy alone.
The researchers concluded that Astragalus polysaccharide injection may reduce bone marrow suppression after chemotherapy.
3. Colorectal Cancer
In a 2019 meta-analysis done by the researchers of China, they evaluated the safety and efficacy of using Astragalus-based Chinese medicines along with chemotherapy as compared to using chemotherapy alone for colorectal cancer treatment. A total of 22 studies involving 1,409 patients were obtained through literature search in PubMed, EMBASE, Ovid, Web of Science, Cochrane Library, Chinese Science and Technology Journals (CQVIP), China Academic Journals (CNKI), and Chinese Biomedical Literature databases.
The meta-analysis found that the combination of Astragalus-based Chinese medicines and chemotherapy may improve tumor response rate in Colorectal cancer patients, improve their quality of life and reduce the adverse events such as neutropenia (low concentration of neutrophils -a type of white blood cell) in the blood, anemia , thrombocytopenia (low platelet counts), nausea and vomiting, diarrhea, and neurotoxicity. However, well-designed large clinical trials are required to establish these findings (Shuang Lin et al, Front Oncol. 2019)
Another study done by the researchers in China evaluated the effect of a combination which included Astragalus membranaceus and Jiaozhe, on the intestinal barrier functions of postoperative colorectal cancer patients. The study found that the combination had protective effects on intestinal barrier dysfunction in postoperative colorectal cancer patients. (Qian-zhu Wang et al, Zhongguo Zhong Xi Yi Jie He Za Zhi., 2015)
4. Astragalus polysaccharide improves Quality of Life of Metastatic Cancer Patients
In a recent study done by the researchers from Taipei, Taiwan, they evaluated the effects of Astragalus polysaccharides (PG2) on cancer-related inflammatory markers and Quality of Life.
The study included 23 patients with metastatic cancer and found that the use of Astragalus polysaccharides may reduce pain, nausea, vomiting and fatigue, as well as improve appetite and sleep. The study also found Astragalus may also reduce different pro-inflammatory markers. (Wen-Chien Huang et al, Cancers (Basel)., 2019)
The study provided preliminary evidence for the association between Astragalus polysaccharides and quality of life in patients with advanced stage cancers. However, well-designed large clinical trials are needed for validating these findings
Researchers from the Mackay Memorial Hospital in Taipei, Taiwan investigated the impact of using Astragalus extract in palliative medicine for managing cancer-related fatigue. The study found that Astragalus polysaccharides might be an effective and safe treatment for relieving cancer-related fatigue among palliative care cancer patients. (Hong-Wen Chen et al, Clin Invest Med. 2012)
6. Impact on Cancer-associated Anorexia in Patients with Advanced Cancer
In a phase II clinical trial conducted in 2010 by the researchers of the East-West NeoMedical Center, Kyung Hee University in Seoul, Korea, they evaluated the efficacy and safety of a herbal decoction with Astragalus extract in cancer patients with anorexia. (Jae Jin Lee et al, Integr Cancer Ther., 2010)
A total of 11 patients with a mean age of 59.8 years who were recruited between January, 2007 to January, 2009 were included in the study. The study found that the use of Astragalus decoction improved appetite and body weight in patients with advanced cancers.
The researchers concluded that the herbal decoction with Astragalus extract may have some potential for managing cancer-related anorexia.
Conclusion
Many preliminary clinical trials, population studies and meta-analyses suggest that Astragalus extract might have the potential to reduce chemotherapy-induced side-effects such as nausea, vomiting, diarrhea, bone-marrow suppression improve the quality of life of advanced cancer patients; improve cancer related fatigue and anorexia; and synergize with certain chemotherapies and improve their therapeutic effectiveness, especially in non-small cell lung cancer. However, astragalus may interact with other drugs leading to adverse events. Hence, random use of Astragalus should be avoided. Talk to your healthcare provider and nutritionist and get personalized advice on nutrition before taking Astragalus extract supplements for lung cancer.
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