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<div class="pre-content"><div><div class="bk_prnt"><p class="small">NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.</p><p>PDQ Cancer Information Summaries [Internet]. Bethesda (MD): National Cancer Institute (US); 2002-. </p></div><div class="iconblock clearfix whole_rhythm no_top_margin bk_noprnt"><a class="img_link icnblk_img" title="Table of Contents Page" href="/books/n/pdqcis/"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-pdqcis-lrg.png" alt="Cover of PDQ Cancer Information Summaries" height="100px" width="80px" /></a><div class="icnblk_cntnt eight_col"><h2>PDQ Cancer Information Summaries [Internet].</h2><a data-jig="ncbitoggler" href="#__NBK563071_dtls__">Show details</a><div style="display:none" class="ui-widget" id="__NBK563071_dtls__"><div>Bethesda (MD): <a href="http://www.cancer.gov/" ref="pagearea=page-banner&targetsite=external&targetcat=link&targettype=publisher">National Cancer Institute (US)</a>; 2002-.</div></div><div class="half_rhythm"></div><div class="bk_noprnt"><form method="get" action="/books/n/pdqcis/" id="bk_srch"><div class="bk_search"><label for="bk_term" class="offscreen_noflow">Search term</label><input type="text" title="Search this book" id="bk_term" name="term" value="" data-jig="ncbiclearbutton" /> <input type="submit" class="jig-ncbibutton" value="Search this book" submit="false" style="padding: 0.1em 0.4em;" /></div></form></div></div></div></div></div>
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<div class="main-content lit-style" itemscope="itemscope" itemtype="http://schema.org/CreativeWork"><div class="meta-content fm-sec"><h1 id="_NBK563071_"><span class="title" itemprop="name">Cancer Therapy Interactions With Foods and Dietary Supplements (PDQ®)</span></h1><div class="subtitle whole_rhythm">Health Professional Version</div><p class="contrib-group"><span itemprop="author">PDQ Integrative, Alternative, and Complementary Therapies Editorial Board</span>.</p><p class="small">Published online: June 10, 2021.</p><p class="small">Created: <span itemprop="datePublished">October 14, 2020</span>.</p></div><div class="jig-ncbiinpagenav body-content whole_rhythm" data-jigconfig="allHeadingLevels: ['h2'],smoothScroll: false" itemprop="text"><div id="_abs_rndgid_" itemprop="description"><p id="CDR0000799261__105">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about the use of foods, dietary supplements, and cancer therapy interactions in people with cancer. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.</p><p id="CDR0000799261__106">This summary is reviewed regularly and updated as necessary by the PDQ Integrative, Alternative, and Complementary Therapies Editorial Board, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p></div><div id="CDR0000799261__68"><h2 id="_CDR0000799261__68_">Overview</h2><p id="CDR0000799261__69">This <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> information summary provides an overview on cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a> interactions with different foods and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373932/" class="def">dietary supplements</a>.</p><p id="CDR0000799261__70">This summary contains the following key information:</p><ul id="CDR0000799261__94"><li class="half_rhythm"><div> The combination of cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> taken by patients and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044964/" class="def">complementary and alternative medicine</a> used may interact, causing <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044922/" class="def">adverse outcomes</a>. </div></li><li class="half_rhythm"><div>Research on dietary supplement and cancer drug <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044324/" class="def">pharmacokinetics</a> (PK) <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454754/" class="def">interactions</a> is limited, but there is evidence for several possible interactions and adverse reactions.</div></li><li class="half_rhythm"><div>For many specific <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043997/" class="def">antioxidant</a> supplements, there is insufficient information available to determine if they are safe and effective as a complementary therapy to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a> cancer treatment.</div></li><li class="half_rhythm"><div>Certain constituents of foods and dietary supplements (e.g., <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044957/" class="def">St. John’s wort</a>, grapefruit juice, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000687277/" class="def">epigallocatechin gallate</a> from green tea) can alter the PK of specific types of drugs.</div></li><li class="half_rhythm"><div>Some research has shown a dietary supplement/food and drug PK interaction between grapefruit juice and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044893/" class="def">imatinib</a>.</div></li></ul></div><div id="CDR0000799261__1"><h2 id="_CDR0000799261__1_">General Information</h2><p id="CDR0000799261__8">For adult <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> patients in the United States, the frequency of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044964/" class="def">complementary and alternative medicine</a> (CAM) use is approximately 36%.[<a class="bk_pop" href="#CDR0000799261_rl_1_1">1</a>] It is possible that the combination of cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> taken by these patients and the CAM they use may interact, causing <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044922/" class="def">adverse outcomes</a>. When <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373932/" class="def">dietary supplements</a>/herbs and cancer drugs are taken together, there is always a risk of the supplement having an impact on the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044324/" class="def">pharmacokinetics</a> (PK) or pharmacodynamics (PD) of the drug. Many <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454754/" class="def">drug interactions</a> occur from the effects of the supplement on specific <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046081/" class="def">enzymes</a> or on components involved in the PK of the drug, such as how the drug is metabolized and transported. Reporting and studying these interactions is important, so health care professionals can help patients navigate CAM usage with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a> cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapies</a>, thus avoiding preventable adverse outcomes.</p><p id="CDR0000799261__164">In the United States, dietary supplements are regulated as foods, not drugs. Therefore, premarket evaluation and approval of such supplements by the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454785/" class="def">U.S. Food and Drug Administration</a> (FDA) are not required unless specific disease <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439419/" class="def">prevention</a> or treatment claims are made. Because dietary supplements are not formally reviewed for manufacturing consistency, ingredients may vary considerably from lot to lot and there is no guarantee that ingredients claimed on product labels are present (or are present in the specified amounts). The FDA has not approved the use of dietary supplements as a treatment for cancer patients.</p><div id="CDR0000799261__9"><h3>Cytochrome P450 Inhibitors/Inducers </h3><p id="CDR0000799261__10">One of the main group of enzymes involved in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046173/" class="def">metabolism</a> of many cancer drugs is the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390266/" class="def">cytochrome P450</a> (CYP) superfamily of enzymes. These enzymes play an important role in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043976/" class="def">activation</a> and inactivation of various drugs. Another component involved in the metabolism and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476338/" class="def">excretion</a> of many drugs is the transport <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046092/" class="def">protein</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643067/" class="def">P-glycoprotein</a> (P-gp). P-gp works in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046335/" class="def">intestine</a> as a drug efflux pump regulating the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044225/" class="def">bioavailability</a> of the drug. Various anticancer drugs are substrates of P-gp; thus, if P-gp or any CYP enzyme is impacted, the drug it is processing will also be impacted.</p><p id="CDR0000799261__11">The PK of a drug predicts <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043985/" class="def">therapeutic</a> outcomes for the patient. Various <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463714/" class="def">herbs</a> and dietary supplements are known to influence the PK of certain drugs, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044957/" class="def">St. John’s wort</a>. Currently, research on dietary supplement and cancer drug PK interactions is limited, but there is evidence for several possible interactions and adverse reactions.[<a class="bk_pop" href="#CDR0000799261_rl_1_1">1</a>-<a class="bk_pop" href="#CDR0000799261_rl_1_3">3</a>]</p></div><div id="CDR0000799261_rl_1"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000799261_rl_1_1">Collado-Borrell R, Escudero-Vilaplana V, Romero-Jiménez R, et al.: Oral antineoplastic agent interactions with medicinal plants and food: an issue to take into account. J Cancer Res Clin Oncol 142 (11): 2319-30, 2016. [<a href="https://pubmed.ncbi.nlm.nih.gov/27316629" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27316629</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_1_2">He SM, Yang AK, Li XT, et al.: Effects of herbal products on the metabolism and transport of anticancer agents. Expert Opin Drug Metab Toxicol 6 (10): 1195-213, 2010. [<a href="https://pubmed.ncbi.nlm.nih.gov/20701553" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20701553</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_1_3">Meijerman I, Beijnen JH, Schellens JH: Herb-drug interactions in oncology: focus on mechanisms of induction. Oncologist 11 (7): 742-52, 2006 Jul-Aug. [<a href="https://pubmed.ncbi.nlm.nih.gov/16880233" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16880233</span></a>]</div></li></ol></div></div><div id="CDR0000799261__175"><h2 id="_CDR0000799261__175_">Antioxidants</h2><div id="CDR0000799261__176"><h3>General information</h3><p id="CDR0000799261__177">Some common dietary <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043997/" class="def">antioxidants</a> include the following: </p><ul id="CDR0000799261__178"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439435/" class="def">Vitamin C</a> (ascorbate).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045023/" class="def">Vitamin E</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000330168/" class="def">Flavonoids</a> (e.g., <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407766/" class="def">soy</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046660/" class="def">isoflavones</a>, green tea <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000686469/" class="def">catechins</a>).</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045328/" class="def">Beta-carotene</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373010/" class="def">Glutathione</a>.</div></li></ul><p id="CDR0000799261__179"> Numerous anticancer agents generate <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000687227/" class="def">reactive oxygen species</a>, which cause decreased levels of antioxidants, <a href="/books/n/pdqcis/glossary_gen/def-item/glossary_gen_CDR0000044393/" class="def">deoxyribonucleic acid</a> damage, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cell</a> death. Antioxidants are taken by many cancer patients because it is thought that the substances will protect and repair healthy cells damaged by cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a>.[<a class="bk_pop" href="#CDR0000799261_rl_175_1">1</a>] There is insufficient information for many specific antioxidant supplements to determine if they are safe and effective as a complementary therapy to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044930/" class="def">standard</a> cancer treatment. </p></div><div id="CDR0000799261__180"><h3>Laboratory/animal/preclinical studies</h3><p id="CDR0000799261__181">A study published in 2018 examined the pharmacokinetic interactions between <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044893/" class="def">imatinib</a> (25 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044213/" class="def">mg</a>/<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044576/" class="def">kg</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044068/" class="def">orally</a>) and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045248/" class="def">vitamin A</a> (12 mg <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046057/" class="def">retinol</a>/kg orally), vitamin E (400 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454523/" class="def">IU</a>/kg orally), <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000427252/" class="def">vitamin D3</a> (100 IU/kg orally), and vitamin C (500 mg/kg orally) when coadministered in rat <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043996/" class="def">animal models</a>. The results showed that there was an increase in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044225/" class="def">bioavailability</a> of imatinib with vitamins A, E , and D, and a decrease in the bioavailability of imatinib with vitamin C.[<a class="bk_pop" href="#CDR0000799261_rl_175_2">2</a>]</p><p id="CDR0000799261__182">A study that examined the oxidized form of ascorbate, dehydroascorbate, as a complementary supplement with chemotherapeutic <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> (i.e., <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000560140/" class="def">doxorubicin</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045230/" class="def">cisplatin</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000615324/" class="def">vincristine</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045393/" class="def">methotrexate</a>, and imatinib) initially found that dehydroascorbate given before doxorubicin treatment caused a reduction of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043985/" class="def">therapeutic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346517/" class="def">efficacy</a> in mice with lymphoma (RL) cell–derived xenogeneic <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumors</a>, This form of ascorbate is not generally available as a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373932/" class="def">dietary supplement</a> and is not used clinically, and it has different properties and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463167/" class="def">pharmacology</a> from unoxidized or reduced ascorbate; thus, the potential <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044168/" class="def">clinical</a> implications of these findings are unknown.[<a class="bk_pop" href="#CDR0000799261_rl_175_3">3</a>]</p><p id="CDR0000799261__183">An <i><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046352/" class="def">in vivo</a></i>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000561606/" class="def">mouse model</a> study observed a possible interaction between vitamin C (40 mg/kg/d) and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269133/" class="def">bortezomib</a>. There was a significant reduction in bortezomib’s anticancer activities with consumption of vitamin C.[<a class="bk_pop" href="#CDR0000799261_rl_175_4">4</a>]</p></div><div id="CDR0000799261__184"><h3>Human/clinical studies</h3><p id="CDR0000799261__185">A study examined pre- and post-<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046450/" class="def">diagnosis</a> antioxidant dietary supplement (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045113/" class="def">selenium</a>; multivitamins; zinc; and vitamins A, C, and E) use in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045269/" class="def">postmenopausal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000444971/" class="def">breast cancer</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000450125/" class="def">survivors.</a> The results showed an increased risk of total <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000496502/" class="def">mortality</a> and worsened <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045861/" class="def">recurrence</a>-free survival with antioxidant dietary supplement use during <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045214/" class="def">chemotherapy</a> or <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">radiation therapy</a>.[<a class="bk_pop" href="#CDR0000799261_rl_175_5">5</a>] A similar study investigated the outcomes for breast cancer patients using antioxidant supplements (vitamins A, C, and E; <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046132/" class="def">carotenoids</a>; and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346488/" class="def">coenzyme Q10)</a> before and during treatment with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045253/" class="def">cyclophosphamide</a>, doxorubicin, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045258/" class="def">paclitaxel</a>. The results showed an increase in hazards of recurrence and death in these patients. Though these <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000618612/" class="def">hazard ratios</a> are not <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044167/" class="def">statistically significant</a>, they both trended in the same direction as those seen in the previous study.[<a class="bk_pop" href="#CDR0000799261_rl_175_6">6</a>] This evidence does give reason to use these supplements with caution and indicates that more research on this topic is needed.</p><p id="CDR0000799261__186"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000691423/" class="def">Alpha-tocopherol</a>, one of eight vitamin E <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000422394/" class="def">compounds</a>, was investigated in a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trial</a> for its impact on <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044922/" class="def">adverse effects</a> from chemotherapy and radiation therapy. Initially, some research suggested that alpha-tocopherol may reduce <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445093/" class="def">toxicity</a> caused by radiation therapy for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257519/" class="def">head and neck cancer</a>. Two <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045858/" class="def">randomized</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044014/" class="def">controlled clinical trials</a> of patients with head and neck cancer who received vitamin E supplementation at a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">dose</a> of 400 IU/day have shown an association with a higher risk of tumor <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045866/" class="def">relapse</a> and a decrease in cancer-free survival.[<a class="bk_pop" href="#CDR0000799261_rl_175_7">7</a>,<a class="bk_pop" href="#CDR0000799261_rl_175_8">8</a>]</p></div><div id="CDR0000799261_rl_175"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000799261_rl_175_1">Ozben T: Antioxidant supplementation on cancer risk and during cancer therapy: an update. Curr Top Med Chem 15 (2): 170-8, 2015. [<a href="https://pubmed.ncbi.nlm.nih.gov/25496272" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25496272</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_175_2">Maher HM, Alzoman NZ, Shehata SM: Ultra-performance LC-MS/MS study of the pharmacokinetic interaction of imatinib with selected vitamin preparations in rats. Bioanalysis 10 (14): 1099-1113, 2018. [<a href="https://pubmed.ncbi.nlm.nih.gov/30047806" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30047806</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_175_3">Heaney ML, Gardner JR, Karasavvas N, et al.: Vitamin C antagonizes the cytotoxic effects of antineoplastic drugs. Cancer Res 68 (19): 8031-8, 2008. [<a href="/pmc/articles/PMC3695824/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3695824</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18829561" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18829561</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_175_4">Perrone G, Hideshima T, Ikeda H, et al.: Ascorbic acid inhibits antitumor activity of bortezomib in vivo. Leukemia 23 (9): 1679-86, 2009. [<a href="https://pubmed.ncbi.nlm.nih.gov/19369963" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19369963</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_175_5">Jung AY, Cai X, Thoene K, et al.: Antioxidant supplementation and breast cancer prognosis in postmenopausal women undergoing chemotherapy and radiation therapy. Am J Clin Nutr 109 (1): 69-78, 2019. [<a href="https://pubmed.ncbi.nlm.nih.gov/30668630" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30668630</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_175_6">Ambrosone CB, Zirpoli GR, Hutson AD, et al.: Dietary Supplement Use During Chemotherapy and Survival Outcomes of Patients With Breast Cancer Enrolled in a Cooperative Group Clinical Trial (SWOG S0221). J Clin Oncol 38 (8): 804-814, 2020. [<a href="/pmc/articles/PMC7062457/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7062457</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31855498" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31855498</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_175_7">Bairati I, Meyer F, Gélinas M, et al.: A randomized trial of antioxidant vitamins to prevent second primary cancers in head and neck cancer patients. J Natl Cancer Inst 97 (7): 481-8, 2005. [<a href="https://pubmed.ncbi.nlm.nih.gov/15812073" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15812073</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_175_8">Bairati I, Meyer F, Jobin E, et al.: Antioxidant vitamins supplementation and mortality: a randomized trial in head and neck cancer patients. Int J Cancer 119 (9): 2221-4, 2006. [<a href="https://pubmed.ncbi.nlm.nih.gov/16841333" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16841333</span></a>]</div></li></ol></div></div><div id="CDR0000799261__107"><h2 id="_CDR0000799261__107_">Herbs</h2><div id="CDR0000799261__108"><h3>Ginseng</h3><div id="CDR0000799261__109"><h4>General information</h4><p id="CDR0000799261__110"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044151/" class="def">Ginseng</a> root has commonly been used as a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373932/" class="def">dietary supplement</a> in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000449722/" class="def">traditional Asian medicine</a>. There are several types of ginseng. While there is no conclusive evidence for the health benefits of ginseng, people currently use it for the following reasons:[<a class="bk_pop" href="#CDR0000799261_rl_107_1">1</a>,<a class="bk_pop" href="#CDR0000799261_rl_107_2">2</a>]</p><ul id="CDR0000799261__111"><li class="half_rhythm"><div>To increase overall well-being and concentration.</div></li><li class="half_rhythm"><div>To strengthen the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046356/" class="def">immune system</a>.</div></li><li class="half_rhythm"><div> To improve health <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>, such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000748138/" class="def">heart disease</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430479/" class="def">depression</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430405/" class="def">anxiety</a>.</div></li></ul></div><div id="CDR0000799261__112"><h4>Laboratory/animal/preclinical studies</h4><p id="CDR0000799261__113">Most <i><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045733/" class="def">in vitro</a></i> research on ginseng’s <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044324/" class="def">pharmacokinetic</a> (PK) <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454754/" class="def">interactions</a> found little evidence of any effects, determining a low risk of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000390266/" class="def">cytochrome P450</a> (CYP)-dependent <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463714/" class="def">herb</a>-<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drug</a> reactions. Overall, the evidence is mixed and inconclusive.[<a class="bk_pop" href="#CDR0000799261_rl_107_3">3</a>-<a class="bk_pop" href="#CDR0000799261_rl_107_5">5</a>]</p></div><div id="CDR0000799261__114"><h4>Case study</h4><p id="CDR0000799261__115">Ginseng was suspected of being responsible for an incident of hepatotoxicity that occurred in a 26-year-old male taking <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044893/" class="def">imatinib</a>. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044209/" class="def">hypothesized</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000797426/" class="def">mechanism</a> for this interaction was inhibition of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045709/" class="def">hepatic</a> CYP3A4, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046081/" class="def">enzyme</a> primarily responsible for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046173/" class="def">metabolizing</a> imatinib. The ginseng was <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044100/" class="def">ingested</a> through a ginseng energy drink, which creates uncertainty about whether the ginseng or the other ingredients in the drink caused the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044922/" class="def">adverse effect</a>. <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000774488/" class="def">Clinical research</a> is needed to confirm if there are any PK interactions between imatinib and ginseng.[<a class="bk_pop" href="#CDR0000799261_rl_107_6">6</a>]</p></div></div><div id="CDR0000799261__118"><h3>Scutellaria baicalensis/wogonin</h3><div id="CDR0000799261__119"><h4>General information</h4><p id="CDR0000799261__120"><i>Scutellaria baicalensis</i>, also known as wogonin, Chinese skullcap, or Huang Qin, is a plant used in traditional Chinese medicine to treat various medical <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000651193/" class="def">conditions</a>, such as the following:[<a class="bk_pop" href="#CDR0000799261_rl_107_7">7</a>]</p><ul id="CDR0000799261__121"><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000306496/" class="def">Diarrhea</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046371/" class="def">Hepatitis</a>.</div></li><li class="half_rhythm"><div>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045364/" class="def">Infections</a>.</div></li><li class="half_rhythm"><div><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044042/" class="def">Inflammation</a>.</div></li></ul><p id="CDR0000799261__122">In traditional Chinese medicine, there are some <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463714/" class="def">herbal</a> mixtures that contain <i>Scutellaria baicalensis</i>, one being Huang Qin Tang. PHY906, a patented formula derived from Huang Qin Tang, is being studied as a potential adjuvant for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapy</a>; there is some evidence that this herbal mixture potentiates the anticancer effects of certain cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a> such as <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000509041/" class="def">sorafenib</a>.[<a class="bk_pop" href="#CDR0000799261_rl_107_8">8</a>] Some research has shown the inhibitory effect of wogonin on the activity of CYP, but more research is needed to determine <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454754/" class="def">interactions</a> with specific drugs.[<a class="bk_pop" href="#CDR0000799261_rl_107_9">9</a>]</p></div><div id="CDR0000799261__123"><h4>Laboratory/animal/preclinical studies</h4><p id="CDR0000799261__124">A 2018 study examined the PK profile and herb-drug interactions of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044068/" class="def">oral</a> wogonin and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046682/" class="def">intravenous</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045382/" class="def">docetaxel</a> in rats with mammary tumors. The investigators found that in rats receiving oral wogonin and docetaxel, the area under the concentration versus time curve (AUC), initial peak serum concentration (C<sub>max</sub>), and half-life for docetaxel increased. The investigators speculated that these increases resulted from the inhibitory effect of wogonin on CYP3A and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643067/" class="def">P-glycoprotein</a> (P-gp). More research is needed with human <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">clinical trials</a>, but these results suggest a possible interaction between wogonin and docetaxel.[<a class="bk_pop" href="#CDR0000799261_rl_107_10">10</a>]</p></div></div><div id="CDR0000799261__125"><h3>St. John’s Wort</h3><div id="CDR0000799261__126"><h4>General information</h4><p id="CDR0000799261__127">The flower of the St. John’s wort (SJW) (<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044462/" class="def">Hypericum perforatum</a>) plant is used traditionally for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000441269/" class="def">wound</a> healing, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044043/" class="def">insomnia</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046325/" class="def">kidney</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000270740/" class="def">lung</a> problems, and most commonly today for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000430479/" class="def">depression</a>. This flower can be taken through teas, tablets, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000455334/" class="def">capsules</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407760/" class="def">extracts</a>. Currently, the evidence for the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044168/" class="def">clinical</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000346517/" class="def">efficacy</a> of SJW is varied, but there have been reports of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454754/" class="def">interactions</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044922/" class="def">adverse effects</a> with several <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a>.[<a class="bk_pop" href="#CDR0000799261_rl_107_11">11</a>]</p></div><div id="CDR0000799261__128"><h4>Laboratory/animal/preclinical studies</h4><p id="CDR0000799261__129">A 2012 study observed the effects of SJW on the PK of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045393/" class="def">methotrexate</a> in a rat <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043996/" class="def">animal model</a>. After coadministration of SJW (300 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044213/" class="def">mg</a>/<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044576/" class="def">kg</a> and 150 mg/kg) and methotrexate, animals that received 300 mg/kg of SJW had a 163% increase in AUC and a 60% increase in C<sub>max</sub> for methotrexate. For animals that received 150 mg/kg of SJW, an increase in AUC (55%) for methotrexate was observed. Overall, the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000496502/" class="def">mortality</a> of the rats treated with SJW combined with methotrexate was higher. The researchers suggested using extreme caution if coadministering these two substances.[<a class="bk_pop" href="#CDR0000799261_rl_107_12">12</a>]</p></div><div id="CDR0000799261__130"><h4>Human/clinical studies</h4><p id="CDR0000799261__131">There are two well-known examples of herb-drug interactions impacting drug PK that have clinical evidence. These two interactions are between SJW and both <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000635811/" class="def">irinotecan</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044893/" class="def">imatinib</a>. After patients were treated with both irinotecan (350 mg/m<sup>2</sup>) and SJW (900 mg/d), one study found a 42% decrease in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045839/" class="def">plasma</a> levels of SN-38, the active <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000462687/" class="def">metabolite</a> of irinotecan. The researchers hypothesized that components of SJW extract, pseudohypericin and hyperforin, interacted with CYP3A4 isoform and P-gp, causing reduction in SN-38. This interaction may cause a loss of irinotecan efficacy.[<a class="bk_pop" href="#CDR0000799261_rl_107_13">13</a>]</p><p id="CDR0000799261__132">A similar <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000467853/" class="def">outcome</a> occurred in two studies that examined treatment with imatinib (400 mg) and SJW (300 mg 3 times a day). In one study, SJW caused a 32% decrease in AUC, a 29% decrease in C<sub>max</sub>, and a 21% decrease in half-life after two weeks of combined treatment with SJW and imatinib.[<a class="bk_pop" href="#CDR0000799261_rl_107_14">14</a>] The second study found that SJW use caused a 43% increase in the clearance of imatinib and a 30% decrease in AUC. This interaction is also thought to be caused by the impact of SJW on CYP3A4, the major <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046081/" class="def">enzyme</a> that metabolizes imatinib.[<a class="bk_pop" href="#CDR0000799261_rl_107_15">15</a>]</p><p id="CDR0000799261__133">Another CYP3A4 substrate that may be impacted by SJW is <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045382/" class="def">docetaxel</a>. A 2014 study with ten <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a> patients investigated the PK interactions of docetaxel (135 mg <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046326/" class="def">IV</a> for 60 min) in combination with SJW (300 mg <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044068/" class="def">orally</a> for 14 days). The results showed a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044167/" class="def">statistically significant</a> decrease of 12% in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000285973/" class="def">mean</a> AUC and an increased clearance of docetaxel.[<a class="bk_pop" href="#CDR0000799261_rl_107_16">16</a>]</p><p id="CDR0000799261__134">Although there is a lack of published research, the use of SJW in patients undergoing treatment with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000367463/" class="def">ixabepilone</a> is not recommended. SJW may cause a decrease in plasma concentrations of ixabepilone. The drug label for ixabepilone states a warning for this possible interaction.[<a class="bk_pop" href="#CDR0000799261_rl_107_17">17</a>]</p></div></div><div id="CDR0000799261__135"><h3>Thunder God Vine </h3><div id="CDR0000799261__136"><h4>General information</h4><p id="CDR0000799261__137">Thunder god vine, also known as <i>Tripterygium wilfordii</i> Hook F, is an herb traditionally used in Chinese medicine for its possible <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044187/" class="def">anti-inflammatory</a>, immunosuppressant, and anticancer effects.[<a class="bk_pop" href="#CDR0000799261_rl_107_18">18</a>] Studies have found that triptolide and celastrol, the active components of thunder god vine, are responsible for these possible effects. Evidence varies for herb-drug interactions and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445093/" class="def">toxicity</a>, which are potentially caused by inhibiting effects on the activity of the CYP450 enzyme system.[<a class="bk_pop" href="#CDR0000799261_rl_107_19">19</a>]</p></div><div id="CDR0000799261__138"><h4>Laboratory/animal/preclinical studies</h4><p id="CDR0000799261__139">A 2017 study investigated the effects of triptolide (10 mg/kg) on the PKs of three different sorafenib <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a> (20, 50, and 100 mg/kg) in rats. The results showed an increase in C<sub>max</sub> and AUC for each sorafenib dose and a decrease in clearance with pretreatment of triptolide. It is hypothesized that this interaction occurred due to triptolide’s possible inhibiting effects on P-gp and CYP3A4 enzymatic activity.[<a class="bk_pop" href="#CDR0000799261_rl_107_20">20</a>]</p></div></div><div id="CDR0000799261_rl_107"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000799261_rl_107_1">Wang CZ, Yuan CS: Ginseng, American. In: Coates PM, Betz JM, Blackman MR, et al., eds.: Encyclopedia of Dietary Supplements. 2nd ed. Informa Healthcare, 2010, pp 339-47.</div></li><li><div class="bk_ref" id="CDR0000799261_rl_107_2">Jia L, Soldati F: Ginseng, Asian. In: Coates PM, Betz JM, Blackman MR, et al., eds.: Encyclopedia of Dietary Supplements. 2nd ed. Informa Healthcare, 2010, pp 348-62.</div></li><li><div class="bk_ref" id="CDR0000799261_rl_107_3">Collado-Borrell R, Escudero-Vilaplana V, Romero-Jiménez R, et al.: Oral antineoplastic agent interactions with medicinal plants and food: an issue to take into account. J Cancer Res Clin Oncol 142 (11): 2319-30, 2016. [<a href="https://pubmed.ncbi.nlm.nih.gov/27316629" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27316629</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_107_4">Goey AK, Mooiman KD, Beijnen JH, et al.: Relevance of in vitro and clinical data for predicting CYP3A4-mediated herb-drug interactions in cancer patients. Cancer Treat Rev 39 (7): 773-83, 2013. [<a href="https://pubmed.ncbi.nlm.nih.gov/23394826" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23394826</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_107_5">Haefeli WE, Carls A: Drug interactions with phytotherapeutics in oncology. Expert Opin Drug Metab Toxicol 10 (3): 359-77, 2014. [<a href="https://pubmed.ncbi.nlm.nih.gov/24387348" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24387348</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_107_6">Bilgi N, Bell K, Ananthakrishnan AN, et al.: Imatinib and Panax ginseng: a potential interaction resulting in liver toxicity. Ann Pharmacother 44 (5): 926-8, 2010. [<a href="https://pubmed.ncbi.nlm.nih.gov/20332334" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20332334</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_107_7">Wang ZL, Wang S, Kuang Y, et al.: A comprehensive review on phytochemistry, pharmacology, and flavonoid biosynthesis of Scutellaria baicalensis. Pharm Biol 56 (1): 465-484, 2018. [<a href="/pmc/articles/PMC6292351/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6292351</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31070530" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31070530</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_107_8">Lam W, Jiang Z, Guan F, et al.: PHY906(KD018), an adjuvant based on a 1800-year-old Chinese medicine, enhanced the anti-tumor activity of Sorafenib by changing the tumor microenvironment. Sci Rep 5: 9384, 2015. [<a href="/pmc/articles/PMC4377583/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4377583</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25819872" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25819872</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_107_9">Li T, Li N, Guo Q, et al.: Inhibitory effects of wogonin on catalytic activity of cytochrome P450 enzyme in human liver microsomes. Eur J Drug Metab Pharmacokinet 36 (4): 249-56, 2011. [<a href="https://pubmed.ncbi.nlm.nih.gov/21713461" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21713461</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_107_10">Wang T, Long F, Jiang G, et al.: Pharmacokinetic properties of wogonin and its herb-drug interactions with docetaxel in rats with mammary tumors. Biomed Chromatogr : e4264, 2018. [<a href="https://pubmed.ncbi.nlm.nih.gov/29679509" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29679509</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_107_11">Field HL, Monti DA, Greeson JM, et al.: St. John's Wort. Int J Psychiatry Med 30 (3): 203-19, 2000. [<a href="https://pubmed.ncbi.nlm.nih.gov/11209989" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11209989</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_107_12">Yang SY, Juang SH, Tsai SY, et al.: St. John's wort significantly increased the systemic exposure and toxicity of methotrexate in rats. Toxicol Appl Pharmacol 263 (1): 39-43, 2012. [<a href="https://pubmed.ncbi.nlm.nih.gov/22699020" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22699020</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_107_13">Mathijssen RH, Verweij J, de Bruijn P, et al.: Effects of St. John's wort on irinotecan metabolism. J Natl Cancer Inst 94 (16): 1247-9, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/12189228" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12189228</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_107_14">Smith P, Bullock JM, Booker BM, et al.: The influence of St. John's wort on the pharmacokinetics and protein binding of imatinib mesylate. Pharmacotherapy 24 (11): 1508-14, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/15537555" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15537555</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_107_15">Frye RF, Fitzgerald SM, Lagattuta TF, et al.: Effect of St John's wort on imatinib mesylate pharmacokinetics. Clin Pharmacol Ther 76 (4): 323-9, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/15470331" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15470331</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_107_16">Goey AK, Meijerman I, Rosing H, et al.: The effect of St John's wort on the pharmacokinetics of docetaxel. Clin Pharmacokinet 53 (1): 103-10, 2014. [<a href="https://pubmed.ncbi.nlm.nih.gov/24068654" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24068654</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_107_17">Ixabepilone. Bethesda, Md: TOXNET, 2009. <a href="https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+hsdb:@term+@DOCNO+7738" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed September 11, 2019.</div></li><li><div class="bk_ref" id="CDR0000799261_rl_107_18">Ziaei S, Halaby R: Immunosuppressive, anti-inflammatory and anti-cancer properties of triptolide: A mini review. Avicenna J Phytomed 6 (2): 149-64, 2016 Mar-Apr. [<a href="/pmc/articles/PMC4877967/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4877967</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27222828" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27222828</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_107_19">Jin C, Wu Z, Wang L, et al.: CYP450s-Activity Relations of Celastrol to Interact with Triptolide Reveal the Reasons of Hepatotoxicity of Tripterygium wilfordii. Molecules 24 (11): , 2019. [<a href="/pmc/articles/PMC6600472/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6600472</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/31181731" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31181731</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_107_20">Wang X, Zhang X, Liu F, et al.: The effects of triptolide on the pharmacokinetics of sorafenib in rats and its potential mechanism. Pharm Biol 55 (1): 1863-1867, 2017. [<a href="/pmc/articles/PMC7011964/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7011964</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28614959" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28614959</span></a>]</div></li></ol></div></div><div id="CDR0000799261__140"><h2 id="_CDR0000799261__140_">Foods</h2><div id="CDR0000799261__141"><h3>Grapefruit</h3><div id="CDR0000799261__142"><h4>General information</h4><p id="CDR0000799261__143">Grapefruit and other similar fruits, such as Seville orange, pomelo, and lime, have been known to <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454754/" class="def">interact</a> with a variety of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a>, including some anticancer drugs. These <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044324/" class="def">pharmacokinetic</a> (PK) interactions may be caused by the furanocoumarin components found in the seeds of grapefruit. These components have been observed impacting the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046173/" class="def">metabolism</a> of substrates of CYP3A4.[<a class="bk_pop" href="#CDR0000799261_rl_140_1">1</a>-<a class="bk_pop" href="#CDR0000799261_rl_140_3">3</a>] </p></div><div id="CDR0000799261__173"><h4>Laboratory/animal/preclinical studies</h4><p id="CDR0000799261__174">Grapefruit and its furanocoumarin components have been studied for their potential <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043997/" class="def">antioxidative</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044187/" class="def">anti-inflammatory</a>, and anticancer effects in <i><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045733/" class="def">in vitro</a></i> and <i><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046352/" class="def">in vivo</a></i> studies.[<a class="bk_pop" href="#CDR0000799261_rl_140_4">4</a>]</p></div><div id="CDR0000799261__144"><h4>Human/clinical studies</h4><p id="CDR0000799261__145">Some research has shown a dietary supplement/food and drug PK interaction between grapefruit juice and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044893/" class="def">imatinib</a>. Grapefruit juice may cause <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045839/" class="def">plasma</a> levels of imatinib to increase by inhibiting CPY3A4, in turn triggering <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000257523/" class="def">organ</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445093/" class="def">toxicity</a>.[<a class="bk_pop" href="#CDR0000799261_rl_140_5">5</a>]</p><p id="CDR0000799261__146">An interaction has been observed between grapefruit juice and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045189/" class="def">etoposide</a>. A <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045858/" class="def">randomized</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000797424/" class="def">crossover</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045838/" class="def">pilot study</a> of six participants examined the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044225/" class="def">bioavailability</a> of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000689103/" class="def">oral chemotherapy</a> drug etoposide after coadministration of grapefruit juice. The data showed a decrease in bioavailability between the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044149/" class="def">control group</a> and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000774371/" class="def">experimental group</a>, who were treated with etoposide and grapefruit juice. The bioavailability of etoposide (50 mg <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044068/" class="def">orally</a>) reduced from approximately 73% to 52% after pretreatment with grapefruit juice (100 <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044214/" class="def">mL</a>). This resulted in a decrease in the area under the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000683342/" class="def">concentration</a> versus time curve (AUC) by 26% for etoposide with grapefruit juice, compared with etoposide alone.[<a class="bk_pop" href="#CDR0000799261_rl_140_6">6</a>]</p><p id="CDR0000799261__147">Other studies have found an increase in the bioavailability of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000468779/" class="def">sunitinib</a> with grapefruit juice exposure,[<a class="bk_pop" href="#CDR0000799261_rl_140_7">7</a>] and an increase in AUC by 29% and an increase in peak <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044088/" class="def">serum</a> concentration (C<sub>max</sub>) by 60% for <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000575396/" class="def">nilotinib</a> (400 mg orally) was also observed when combined with grapefruit juice (240 mL).[<a class="bk_pop" href="#CDR0000799261_rl_140_8">8</a>]</p></div></div><div id="CDR0000799261__148"><h3>Green Tea</h3><div id="CDR0000799261__149"><h4>General information</h4><p id="CDR0000799261__150">Green tea, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000389271/" class="def">green tea extract</a>, and products of green tea components are commonly taken as foods, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373932/" class="def">dietary supplements</a>, and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463714/" class="def">herbal</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044737/" class="def">therapies</a>. Some of the traditional and modern uses of green tea include the following:</p><ul id="CDR0000799261__151"><li class="half_rhythm"><div>Preventing and treating <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045333/" class="def">cancer</a>.</div></li><li class="half_rhythm"><div>Lowering <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000407756/" class="def">cholesterol</a>.</div></li><li class="half_rhythm"><div>Promoting weight loss.</div></li><li class="half_rhythm"><div>Improving mental alertness.</div></li><li class="half_rhythm"><div>Helping with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046446/" class="def">digestive</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a>.</div></li></ul><p id="CDR0000799261__152">Research has been mixed on whether green tea is safe or effective for these uses as well as for coadministration with anticancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a>.[<a class="bk_pop" href="#CDR0000799261_rl_140_9">9</a>] Current research shows that green tea and the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000256573/" class="def">polyphenol</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000687277/" class="def">epigallocatechin gallate</a> (EGCG), an <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043997/" class="def">antioxidant</a> component of green tea, can impact the PK or pharmacodynamics (PD) of certain <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drugs</a>, thus impacting the metabolism and effectiveness of these drugs.[<a class="bk_pop" href="#CDR0000799261_rl_140_10">10</a>]</p></div><div id="CDR0000799261__153"><h4>Laboratory/animal/preclinical studies</h4><p id="CDR0000799261__154">As seen in the literature, green tea and its constituent EGCG may be involved in both PK and PD interactions. An interaction between green tea and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269133/" class="def">bortezomib</a> was examined in an <i>in vitro</i> study with human <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045793/" class="def">multiple myeloma</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045698/" class="def">glioblastoma</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044016/" class="def">cell lines</a>. EGCG blocked bortezomib’s <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045977/" class="def">protease inhibitory</a> function by binding to the boronic <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000642987/" class="def">acid</a> structure in bortezomib, causing the inability to induce cancer <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046476/" class="def">cell</a> death and consequently blocking its anticancer abilities. The second portion of this study investigated this interaction within a <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046231/" class="def">plasmacytoma</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044095/" class="def">xenograft</a> nude <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000561606/" class="def">mouse model</a>. Bortezomib’s cancer cell <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046524/" class="def">apoptosis</a>-inducing effect was completely prevented with intragastric EGCG <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000478733/" class="def">administration</a> (50 mg/kg).[<a class="bk_pop" href="#CDR0000799261_rl_140_11">11</a>] This interaction was also reported in another <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454774/" class="def">animal study</a> that examined human <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000445079/" class="def">prostate cancer</a> xenografts in immune-deficient mouse models. High <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046682/" class="def">intravenous</a> (IV) <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044664/" class="def">doses</a> of EGCG along with the coadministration of bortezomib resulted in the abrogation of bortezomib’s anticancer effects.[<a class="bk_pop" href="#CDR0000799261_rl_140_12">12</a>] Human studies should be conducted to determine <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044168/" class="def">clinical</a> significance. </p><p id="CDR0000799261__155">The impact of green tea and EGCG on <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046090/" class="def">fluorouracil</a> PK was studied in rats. The results of these studies showed a 151% increase in C<sub>max</sub> and a 425% increase in AUC for fluorouracil. The researchers concluded that green tea greatly impacted the PK of fluorouracil.[<a class="bk_pop" href="#CDR0000799261_rl_140_13">13</a>]</p><p id="CDR0000799261__156">A similar study examined the PK of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000635811/" class="def">irinotecan</a> (10 mg/kg IV) given in combination with EGCG (20 mg/kg IV) in rats and found that EGCG caused elevated <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045839/" class="def">plasma</a> levels and reduced <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415544/" class="def">hepatobiliary</a> excretion of irinotecan and its <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000462687/" class="def">metabolite</a> SN-38. This is possibly because of EGCG’s inhibitory effects on <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000643067/" class="def">P-glycoprotein</a> (Pgp).[<a class="bk_pop" href="#CDR0000799261_rl_140_14">14</a>]</p><p id="CDR0000799261__157">A 2019 study evaluated the effects of green tea extract on the PK of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000768872/" class="def">palbociclib</a> in a rat <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000043996/" class="def">animal model</a>. The data showed a decrease in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044068/" class="def">oral</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044225/" class="def">bioavailability</a> of palbociclib when it was coadministered with green tea extract, but there was no impact on the elimination of palbociclib. The <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044643/" class="def">altered</a> PK was thought to be the result of interference in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463702/" class="def">absorption</a> of palbociclib. The authors recommended against the coadministration of these <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000422394/" class="def">compounds</a>.[<a class="bk_pop" href="#CDR0000799261_rl_140_15">15</a>]</p><p id="CDR0000799261__158">Research on rat animal models investigated the impact of green tea extract on the oral bioavailability of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000508929/" class="def">erlotinib</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000539453/" class="def">lapatinib</a>. A decrease in the oral bioavailability for erlotinib and lapatinib was observed after consumption of green tea extract (200 mg/kg). There was a decrease in AUC by 68% for erlotinib and 70% for lapatinib with short-term administration of green tea extract, and a decrease in AUC by 16% for erlotinib and 14% for lapatinib with long-term administration of green tea extract.[<a class="bk_pop" href="#CDR0000799261_rl_140_16">16</a>]</p><p id="CDR0000799261__159">An <i>in vivo</i> and <i>in vitro</i> study examined the impacts of intragastric coadministration of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000468779/" class="def">sunitinib</a> with EGCG. Coadministration of these two solutions resulted in the formation of a precipitate in the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046604/" class="def">stomachs</a> of the mice, thus decreasing its bioavailability. It was also reported that a decrease in the AUC and C<sub>max</sub> of plasma sunitinib with EGCG administration in rats resulted in reduced sunitinib absorption.[<a class="bk_pop" href="#CDR0000799261_rl_140_17">17</a>]</p><p id="CDR0000799261__160">A possible interaction was also found between EGCG and tamoxifen. A 2009 study assessed the bioavailability and PK of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000509341/" class="def">tamoxifen</a> (2 mg/kg) and its metabolite, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000386195/" class="def">4-hydroxytamoxifen</a>, with coadministration of EGCG (0.5 mg/kg, 3 mg/kg, and 10 mg/kg) in Sprague-Dawley rats. The coadministration of EGCG at doses of 3 mg/kg and 10 mg/kg caused a 49% to 78% increase in the bioavailability of tamoxifen. In addition, EGCG significantly impacted the formation of 4-hydroxytamoxifen. It is believed that this reaction was caused by EGCG’s inhibitory effect on P-gp and CYP3A.[<a class="bk_pop" href="#CDR0000799261_rl_140_18">18</a>]</p><p id="CDR0000799261__161">The findings of the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044517/" class="def">preclinical studies</a> provide a justification and motivation for human studies to determine appropriate clinical recommendations.</p></div><div id="CDR0000799261__162"><h4>Case study</h4><p id="CDR0000799261__163">In addition to the <i>in vitro</i> and <i>in vivo</i> EGCG and sunitinib study mentioned above, the same researchers published a case study that might demonstrate a possible <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044922/" class="def">adverse effect</a> of green tea consumption with sunitinib treatment. A male patient with <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044058/" class="def">metastatic</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000661352/" class="def">renal cell carcinoma</a> who received sunitinib reported worsened symptoms of hyperemia and eye swelling near the site of a metastatic <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046324/" class="def">lesion</a> when drinking green tea; the symptoms improved when he stopped taking green tea. The authors hypothesized that the lack of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269453/" class="def">symptom control</a> may result from EGCG’s effects on sunitinib’s anticancer abilities.[<a class="bk_pop" href="#CDR0000799261_rl_140_17">17</a>]</p></div></div><div id="CDR0000799261_rl_140"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000799261_rl_140_1">Mouly S, Lloret-Linares C, Sellier PO, et al.: Is the clinical relevance of drug-food and drug-herb interactions limited to grapefruit juice and Saint-John's Wort? Pharmacol Res 118: 82-92, 2017. [<a href="https://pubmed.ncbi.nlm.nih.gov/27693910" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27693910</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_140_2">Singh BN: Effects of food on clinical pharmacokinetics. Clin Pharmacokinet 37 (3): 213-55, 1999. [<a href="https://pubmed.ncbi.nlm.nih.gov/10511919" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 10511919</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_140_3">Paine MF, Widmer WW, Hart HL, et al.: A furanocoumarin-free grapefruit juice establishes furanocoumarins as the mediators of the grapefruit juice-felodipine interaction. Am J Clin Nutr 83 (5): 1097-105, 2006. [<a href="https://pubmed.ncbi.nlm.nih.gov/16685052" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16685052</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_140_4">Hung WL, Suh JH, Wang Y: Chemistry and health effects of furanocoumarins in grapefruit. J Food Drug Anal 25 (1): 71-83, 2017. [<a href="/pmc/articles/PMC9333421/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9333421</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28911545" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28911545</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_140_5">He SM, Yang AK, Li XT, et al.: Effects of herbal products on the metabolism and transport of anticancer agents. Expert Opin Drug Metab Toxicol 6 (10): 1195-213, 2010. [<a href="https://pubmed.ncbi.nlm.nih.gov/20701553" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20701553</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_140_6">Reif S, Nicolson MC, Bisset D, et al.: Effect of grapefruit juice intake on etoposide bioavailability. Eur J Clin Pharmacol 58 (7): 491-4, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/12389073" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12389073</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_140_7">van Erp NP, Baker SD, Zandvliet AS, et al.: Marginal increase of sunitinib exposure by grapefruit juice. Cancer Chemother Pharmacol 67 (3): 695-703, 2011. [<a href="/pmc/articles/PMC3043256/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3043256</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20512335" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20512335</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_140_8">Yin OQ, Gallagher N, Li A, et al.: Effect of grapefruit juice on the pharmacokinetics of nilotinib in healthy participants. J Clin Pharmacol 50 (2): 188-94, 2010. [<a href="https://pubmed.ncbi.nlm.nih.gov/19948946" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19948946</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_140_9">Sang S, Lambert JD, Ho C, et al.: Green tea polyphenols. In: Coates PM, Betz JM, Blackman MR, et al., eds.: Encyclopedia of Dietary Supplements. 2nd ed. Informa Healthcare, 2010, pp 402-10.</div></li><li><div class="bk_ref" id="CDR0000799261_rl_140_10">Du GJ, Zhang Z, Wen XD, et al.: Epigallocatechin Gallate (EGCG) is the most effective cancer chemopreventive polyphenol in green tea. Nutrients 4 (11): 1679-91, 2012. [<a href="/pmc/articles/PMC3509513/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3509513</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/23201840" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 23201840</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_140_11">Golden EB, Lam PY, Kardosh A, et al.: Green tea polyphenols block the anticancer effects of bortezomib and other boronic acid-based proteasome inhibitors. Blood 113 (23): 5927-37, 2009. [<a href="https://pubmed.ncbi.nlm.nih.gov/19190249" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19190249</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_140_12">Bannerman B, Xu L, Jones M, et al.: Preclinical evaluation of the antitumor activity of bortezomib in combination with vitamin C or with epigallocatechin gallate, a component of green tea. Cancer Chemother Pharmacol 68 (5): 1145-54, 2011. [<a href="/pmc/articles/PMC3215871/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3215871</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21400028" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21400028</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_140_13">Qiao J, Gu C, Shang W, et al.: Effect of green tea on pharmacokinetics of 5-fluorouracil in rats and pharmacodynamics in human cell lines in vitro. Food Chem Toxicol 49 (6): 1410-5, 2011. [<a href="https://pubmed.ncbi.nlm.nih.gov/21440026" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21440026</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_140_14">Lin LC, Wang MN, Tsai TH: Food-drug interaction of (-)-epigallocatechin-3-gallate on the pharmacokinetics of irinotecan and the metabolite SN-38. Chem Biol Interact 174 (3): 177-82, 2008. [<a href="https://pubmed.ncbi.nlm.nih.gov/18579105" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18579105</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_140_15">Paul D, Surendran S, Chandrakala P, et al.: An assessment of the impact of green tea extract on palbociclib pharmacokinetics using a validated UHPLC-QTOF-MS method. Biomed Chromatogr 33 (4): e4469, 2019. [<a href="https://pubmed.ncbi.nlm.nih.gov/30549069" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30549069</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_140_16">Maher HM, Alzoman NZ, Shehata SM, et al.: UPLC-ESI-MS/MS study of the effect of green tea extract on the oral bioavailability of erlotinib and lapatinib in rats: Potential risk of pharmacokinetic interaction. J Chromatogr B Analyt Technol Biomed Life Sci 1049-1050: 30-40, 2017. [<a href="https://pubmed.ncbi.nlm.nih.gov/28260629" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28260629</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_140_17">Ge J, Tan BX, Chen Y, et al.: Interaction of green tea polyphenol epigallocatechin-3-gallate with sunitinib: potential risk of diminished sunitinib bioavailability. J Mol Med (Berl) 89 (6): 595-602, 2011. [<a href="https://pubmed.ncbi.nlm.nih.gov/21331509" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21331509</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_140_18">Shin SC, Choi JS: Effects of epigallocatechin gallate on the oral bioavailability and pharmacokinetics of tamoxifen and its main metabolite, 4-hydroxytamoxifen, in rats. Anticancer Drugs 20 (7): 584-8, 2009. [<a href="https://pubmed.ncbi.nlm.nih.gov/19491656" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19491656</span></a>]</div></li></ol></div></div><div id="CDR0000799261__88"><h2 id="_CDR0000799261__88_">Foods, Dietary Supplements, and Cancer Drug Interaction Tables</h2><div id="CDR0000799261__89" class="table"><h3><span class="title"> Table 1. Foods, Dietary Supplements, and Cancer Drug Interactions</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK563071.2/table/CDR0000799261__89/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000799261__89_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463714/" class="def">Herbal</a><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000373932/" class="def">Dietary Supplement</a>/</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000639945/" class="def">Anticancer Therapy</a></th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Effect</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Study Type</th></tr></thead><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044957/" class="def">SJW</a></td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000635811/" class="def">Irinotecan</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased activity of CYP3A4 and decreased AUC of active <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000462687/" class="def">metabolite</a> SN38</td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045961/" class="def">Clinical trial</a> [<a class="bk_pop" href="#CDR0000799261_rl_88_1">1</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">SJW</td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044893/" class="def">Imatinib</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased clearance and decreased AUC of imatinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Clinical trial [<a class="bk_pop" href="#CDR0000799261_rl_88_2">2</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">SJW</td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045393/" class="def">Methotrexate</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased AUC and C<sub>max</sub> of methotrexate</td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000454774/" class="def">Animal study</a> [<a class="bk_pop" href="#CDR0000799261_rl_88_3">3</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">SJW</td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045382/" class="def">Docetaxel</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased clearance and decreased AUC of docetaxel</td><td colspan="1" rowspan="1" style="vertical-align:top;">Clinical trial [<a class="bk_pop" href="#CDR0000799261_rl_88_4">4</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">SJW</td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000367463/" class="def">Ixabepilone</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">May decrease <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045839/" class="def">plasma</a> concentrations of ixabepilone</td><td colspan="1" rowspan="1" style="vertical-align:top;">Label warning for ixabepilone [<a class="bk_pop" href="#CDR0000799261_rl_88_5">5</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Green tea</td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000468779/" class="def">Sunitinib</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Decreased <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000348921/" class="def">drug</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000463702/" class="def">absorption</a> and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044225/" class="def">bioavailability</a> of sunitinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study and <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044007/" class="def">case report</a> [<a class="bk_pop" href="#CDR0000799261_rl_88_6">6</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Green tea</td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000768872/" class="def">Palbociclib</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Decreased <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044068/" class="def">oral</a> bioavailability of palbociclib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_7">7</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000389271/" class="def">Green tea extract</a></td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000508929/" class="def">Erlotinib</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Decreased AUC and oral bioavailability of erlotinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_8">8</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Green tea extract</td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000539453/" class="def">Lapatinib</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Decreased AUC and oral bioavailability of lapatinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_8">8</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000687277/" class="def">EGCG</a></td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000509341/" class="def">Tamoxifen</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased bioavailability of tamoxifen</td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_9">9</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">EGCG</td><td colspan="1" rowspan="1" style="vertical-align:top;">Irinotecan</td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased plasma concentration of irinotecan and decreased <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000415544/" class="def">hepatobiliary</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000476338/" class="def">excretion</a> of drug and its metabolite SN-38</td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_10">10</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Green tea and EGCG</td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046090/" class="def">Fluorouracil</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased AUC and C<sub>max</sub> of fluorouracil</td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal and <i><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045733/" class="def">in vitro</a></i> study [<a class="bk_pop" href="#CDR0000799261_rl_88_11">11</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Grapefruit</td><td colspan="1" rowspan="1" style="vertical-align:top;">Imatinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">May increase plasma levels of imatinib by inhibiting CPY3A4</td><td colspan="1" rowspan="1" style="vertical-align:top;">Review [<a class="bk_pop" href="#CDR0000799261_rl_88_12">12</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Grapefruit</td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045189/" class="def">Etoposide</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Decreased AUC and bioavailability of etoposide</td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045858/" class="def">Randomized</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000797424/" class="def">crossover</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045838/" class="def">pilot study</a> [<a class="bk_pop" href="#CDR0000799261_rl_88_13">13</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Grapefruit</td><td colspan="1" rowspan="1" style="vertical-align:top;">Sunitinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased bioavailability of sunitinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Clinical trial [<a class="bk_pop" href="#CDR0000799261_rl_88_14">14</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Grapefruit</td><td colspan="1" rowspan="1" style="vertical-align:top;">Nilotinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased AUC and C<sub>max</sub> of nilotinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Clinical trial [<a class="bk_pop" href="#CDR0000799261_rl_88_15">15</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045248/" class="def">Vitamin A</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Imatinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased bioavailability of imatinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_8">8</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045023/" class="def">Vitamin E</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Imatinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased bioavailability of imatinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_8">8</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000427252/" class="def">Vitamin D3</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Imatinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased bioavailability of imatinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_8">8</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000439435/" class="def">Vitamin C</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Imatinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Decreased bioavailability of imatinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_8">8</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Scutellaria baicalensis</td><td colspan="1" rowspan="1" style="vertical-align:top;">Docetaxel</td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased AUC of drug and exposure to both drug and herb</td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_16">16</a>]</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">AUC = area under the <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000683342/" class="def">concentration</a> versus time curve; C<sub>max</sub> = peak <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044088/" class="def">serum</a> concentration; EGCG = epigallocatechin gallate; SJW = St. John's wort.</p></div></dd></dl></div></div></div><div id="CDR0000799261__90" class="table"><h3><span class="title">Table 2. Foods, Dietary Supplements, and Cancer Drug Interactions</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK563071.2/table/CDR0000799261__90/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000799261__90_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Anticancer Therapy </th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Herbal/Dietary Supplement </th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Effect </th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Study Type </th></tr></thead><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;"> Docetaxel</td><td colspan="1" rowspan="1" style="vertical-align:top;">Scutellaria baicalensis </td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased AUC of drug and exposure to both drug and herb </td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_16">16</a>] </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Docetaxel </td><td colspan="1" rowspan="1" style="vertical-align:top;">SJW</td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased clearance and decrease AUC of docetaxel </td><td colspan="1" rowspan="1" style="vertical-align:top;">Clinical trial [<a class="bk_pop" href="#CDR0000799261_rl_88_4">4</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Erlotinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Green tea extract</td><td colspan="1" rowspan="1" style="vertical-align:top;">Decreased AUC and oral bioavailability of erlotinib </td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_8">8</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Etoposide </td><td colspan="1" rowspan="1" style="vertical-align:top;">Grapefruit </td><td colspan="1" rowspan="1" style="vertical-align:top;">Decreased AUC and bioavailability of etoposide </td><td colspan="1" rowspan="1" style="vertical-align:top;">Randomized, crossover, pilot study [<a class="bk_pop" href="#CDR0000799261_rl_88_13">13</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Fluorouracil</td><td colspan="1" rowspan="1" style="vertical-align:top;">Green tea and EGCG</td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased AUC and C<sub>max</sub> of fluorouracil </td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal and <i>in vitro</i> study [<a class="bk_pop" href="#CDR0000799261_rl_88_11">11</a>] </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Imatinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Grapefruit </td><td colspan="1" rowspan="1" style="vertical-align:top;">May increase plasma levels of imatinib by inhibiting CPY3A4 </td><td colspan="1" rowspan="1" style="vertical-align:top;">Review [<a class="bk_pop" href="#CDR0000799261_rl_88_12">12</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Imatinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Vitamin A </td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased bioavailability of imatinib </td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_8">8</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Imatinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Vitamin E </td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased bioavailability of imatinib </td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_8">8</a>] </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Imatinib </td><td colspan="1" rowspan="1" style="vertical-align:top;">Vitamin D3 </td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased bioavailability of imatinib </td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_8">8</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Imatinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Vitamin C </td><td colspan="1" rowspan="1" style="vertical-align:top;">Decreased bioavailability of imatinib </td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_8">8</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Imatinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">SJW</td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased clearance and decreased AUC of imatinib </td><td colspan="1" rowspan="1" style="vertical-align:top;">Clinical trial [<a class="bk_pop" href="#CDR0000799261_rl_88_2">2</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Irinotecan </td><td colspan="1" rowspan="1" style="vertical-align:top;">SJW </td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased activity of CYP3A4 and decreased AUC of active metabolite SN38 </td><td colspan="1" rowspan="1" style="vertical-align:top;">Clinical trial [<a class="bk_pop" href="#CDR0000799261_rl_88_1">1</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Irinotecan </td><td colspan="1" rowspan="1" style="vertical-align:top;">EGCG </td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased plasma concentration of irinotecan and decreased hepatobiliary excretion of drug and its metabolite SN-38 </td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_10">10</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Ixabepilone </td><td colspan="1" rowspan="1" style="vertical-align:top;">SJW </td><td colspan="1" rowspan="1" style="vertical-align:top;">May decrease plasma concentrations of ixabepilone </td><td colspan="1" rowspan="1" style="vertical-align:top;">Label warning for ixabepilone [<a class="bk_pop" href="#CDR0000799261_rl_88_5">5</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Lapatinib </td><td colspan="1" rowspan="1" style="vertical-align:top;">Green tea extract </td><td colspan="1" rowspan="1" style="vertical-align:top;">Decreased AUC and oral bioavailability of lapatinib </td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_8">8</a>] </td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Methotrexate </td><td colspan="1" rowspan="1" style="vertical-align:top;">SJW </td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased AUC and C<sub>max</sub> of methotrexate </td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_3">3</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Nilotinib </td><td colspan="1" rowspan="1" style="vertical-align:top;">Grapefruit </td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased AUC and C<sub>max</sub> of nilotinib </td><td colspan="1" rowspan="1" style="vertical-align:top;">Clinical trial [<a class="bk_pop" href="#CDR0000799261_rl_88_15">15</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Palbociclib </td><td colspan="1" rowspan="1" style="vertical-align:top;">Green tea </td><td colspan="1" rowspan="1" style="vertical-align:top;">Decreased oral bioavailability of palbociclib </td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_7">7</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Tamoxifen </td><td colspan="1" rowspan="1" style="vertical-align:top;">EGCG </td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased bioavailability of tamoxifen </td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_9">9</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Sunitinib </td><td colspan="1" rowspan="1" style="vertical-align:top;">Grapefruit </td><td colspan="1" rowspan="1" style="vertical-align:top;">Increased bioavailability of sunitinib </td><td colspan="1" rowspan="1" style="vertical-align:top;">Clinical trial [<a class="bk_pop" href="#CDR0000799261_rl_88_14">14</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Sunitinib </td><td colspan="1" rowspan="1" style="vertical-align:top;">Green tea </td><td colspan="1" rowspan="1" style="vertical-align:top;">Decreased drug absorption and bioavailability of sunitinib </td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study and case report [<a class="bk_pop" href="#CDR0000799261_rl_88_6">6</a>]</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">AUC = area under the concentration versus time curve; C<sub>max</sub> = peak serum concentration; EGCG = epigallocatechin gallate; SJW = St. John's wort.</p></div></dd></dl></div></div></div><div id="CDR0000799261__91" class="table"><h3><span class="title">Table 3. Foods, Dietary Supplements, and Cancer Therapies Adverse Reaction</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK563071.2/table/CDR0000799261__91/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__CDR0000799261__91_lrgtbl__"><table class="no_margin"><thead><tr><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Herbal/Dietary Supplement</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Cancer Therapy</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Adverse Reaction</th><th colspan="1" rowspan="1" style="text-align:center;vertical-align:top;">Study Type</th></tr></thead><tbody><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Vitamin C</td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000560140/" class="def">Doxorubicin</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045230/" class="def">cisplatin</a>, <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000615324/" class="def">vincristine</a>, methotrexate, and imatinib</td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044110/" class="def">Dose-dependent</a> decrease in <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046524/" class="def">apoptosis</a> with all <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044009/" class="def">chemotherapeutic drugs</a> tested</td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_17">17</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Vitamin C</td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000269133/" class="def">Bortezomib</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Decreased bortezomib’s anticancer activities</td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_18">18</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Dl-alpha-tocopherol (vitamin E)</td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044971/" class="def">Radiation therapy</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Higher risk of <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000046634/" class="def">tumor</a>
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<a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045866/" class="def">relapse</a> and increased all-cause <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000496502/" class="def">mortality</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Clinical trial [<a class="bk_pop" href="#CDR0000799261_rl_88_19">19</a>,<a class="bk_pop" href="#CDR0000799261_rl_88_20">20</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044151/" class="def">Ginseng</a></td><td colspan="1" rowspan="1" style="vertical-align:top;">Imatinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Incident of hepatotoxicity</td><td colspan="1" rowspan="1" style="vertical-align:top;">Case report [<a class="bk_pop" href="#CDR0000799261_rl_88_21">21</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">EGCG or green tea extract</td><td colspan="1" rowspan="1" style="vertical-align:top;">Bortezomib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Decreased anticancer effect by neutralizing effects of bortezomib</td><td colspan="1" rowspan="1" style="vertical-align:top;"><i>In vitro</i> and animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_22">22</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">EGCG</td><td colspan="1" rowspan="1" style="vertical-align:top;">Bortezomib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Decreased bortezomib’s anticancer effect</td><td colspan="1" rowspan="1" style="vertical-align:top;">Animal study [<a class="bk_pop" href="#CDR0000799261_rl_88_23">23</a>]</td></tr><tr><td colspan="1" rowspan="1" style="vertical-align:top;">Green tea</td><td colspan="1" rowspan="1" style="vertical-align:top;">Sunitinib</td><td colspan="1" rowspan="1" style="vertical-align:top;">Decreased anticancer effect, worsened <a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000045022/" class="def">symptoms</a></td><td colspan="1" rowspan="1" style="vertical-align:top;"><a href="/books/n/pdqcis/glossary/def-item/glossary_CDR0000044517/" class="def">Preclinical research</a> and case report [<a class="bk_pop" href="#CDR0000799261_rl_88_6">6</a>]</td></tr></tbody></table></div><div><div><dl class="temp-labeled-list small"><dt></dt><dd><div><p class="no_margin">EGCG = epigallocatechin gallate.</p></div></dd></dl></div></div></div><div id="CDR0000799261_rl_88"><h3>References</h3><ol><li><div class="bk_ref" id="CDR0000799261_rl_88_1">Mathijssen RH, Verweij J, de Bruijn P, et al.: Effects of St. John's wort on irinotecan metabolism. J Natl Cancer Inst 94 (16): 1247-9, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/12189228" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12189228</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_2">Frye RF, Fitzgerald SM, Lagattuta TF, et al.: Effect of St John's wort on imatinib mesylate pharmacokinetics. Clin Pharmacol Ther 76 (4): 323-9, 2004. [<a href="https://pubmed.ncbi.nlm.nih.gov/15470331" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 15470331</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_3">Yang SY, Juang SH, Tsai SY, et al.: St. John's wort significantly increased the systemic exposure and toxicity of methotrexate in rats. Toxicol Appl Pharmacol 263 (1): 39-43, 2012. [<a href="https://pubmed.ncbi.nlm.nih.gov/22699020" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 22699020</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_4">Clairet AL, Boiteux-Jurain M, Curtit E, et al.: Interaction between phytotherapy and oral anticancer agents: prospective study and literature review. Med Oncol 36 (5): 45, 2019. [<a href="https://pubmed.ncbi.nlm.nih.gov/30993543" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30993543</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_5">Ixabepilone. Bethesda, Md: TOXNET, 2009. <a href="https://toxnet.nlm.nih.gov/cgi-bin/sis/search2/r?dbs+hsdb:@term+@DOCNO+7738" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">Available online</a>. Last accessed September 11, 2019.</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_6">Ge J, Tan BX, Chen Y, et al.: Interaction of green tea polyphenol epigallocatechin-3-gallate with sunitinib: potential risk of diminished sunitinib bioavailability. J Mol Med (Berl) 89 (6): 595-602, 2011. [<a href="https://pubmed.ncbi.nlm.nih.gov/21331509" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21331509</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_7">Paul D, Surendran S, Chandrakala P, et al.: An assessment of the impact of green tea extract on palbociclib pharmacokinetics using a validated UHPLC-QTOF-MS method. Biomed Chromatogr 33 (4): e4469, 2019. [<a href="https://pubmed.ncbi.nlm.nih.gov/30549069" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30549069</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_8">Maher HM, Alzoman NZ, Shehata SM: Ultra-performance LC-MS/MS study of the pharmacokinetic interaction of imatinib with selected vitamin preparations in rats. Bioanalysis 10 (14): 1099-1113, 2018. [<a href="https://pubmed.ncbi.nlm.nih.gov/30047806" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30047806</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_9">Shin SC, Choi JS: Effects of epigallocatechin gallate on the oral bioavailability and pharmacokinetics of tamoxifen and its main metabolite, 4-hydroxytamoxifen, in rats. Anticancer Drugs 20 (7): 584-8, 2009. [<a href="https://pubmed.ncbi.nlm.nih.gov/19491656" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19491656</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_10">Lin LC, Wang MN, Tsai TH: Food-drug interaction of (-)-epigallocatechin-3-gallate on the pharmacokinetics of irinotecan and the metabolite SN-38. Chem Biol Interact 174 (3): 177-82, 2008. [<a href="https://pubmed.ncbi.nlm.nih.gov/18579105" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18579105</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_11">Qiao J, Gu C, Shang W, et al.: Effect of green tea on pharmacokinetics of 5-fluorouracil in rats and pharmacodynamics in human cell lines in vitro. Food Chem Toxicol 49 (6): 1410-5, 2011. [<a href="https://pubmed.ncbi.nlm.nih.gov/21440026" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21440026</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_12">He SM, Yang AK, Li XT, et al.: Effects of herbal products on the metabolism and transport of anticancer agents. Expert Opin Drug Metab Toxicol 6 (10): 1195-213, 2010. [<a href="https://pubmed.ncbi.nlm.nih.gov/20701553" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20701553</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_13">Reif S, Nicolson MC, Bisset D, et al.: Effect of grapefruit juice intake on etoposide bioavailability. Eur J Clin Pharmacol 58 (7): 491-4, 2002. [<a href="https://pubmed.ncbi.nlm.nih.gov/12389073" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12389073</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_14">van Erp NP, Baker SD, Zandvliet AS, et al.: Marginal increase of sunitinib exposure by grapefruit juice. Cancer Chemother Pharmacol 67 (3): 695-703, 2011. [<a href="/pmc/articles/PMC3043256/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3043256</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/20512335" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20512335</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_15">Yin OQ, Gallagher N, Li A, et al.: Effect of grapefruit juice on the pharmacokinetics of nilotinib in healthy participants. J Clin Pharmacol 50 (2): 188-94, 2010. [<a href="https://pubmed.ncbi.nlm.nih.gov/19948946" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19948946</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_16">Wang T, Long F, Jiang G, et al.: Pharmacokinetic properties of wogonin and its herb-drug interactions with docetaxel in rats with mammary tumors. Biomed Chromatogr : e4264, 2018. [<a href="https://pubmed.ncbi.nlm.nih.gov/29679509" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29679509</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_17">Heaney ML, Gardner JR, Karasavvas N, et al.: Vitamin C antagonizes the cytotoxic effects of antineoplastic drugs. Cancer Res 68 (19): 8031-8, 2008. [<a href="/pmc/articles/PMC3695824/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3695824</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/18829561" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 18829561</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_18">Perrone G, Hideshima T, Ikeda H, et al.: Ascorbic acid inhibits antitumor activity of bortezomib in vivo. Leukemia 23 (9): 1679-86, 2009. [<a href="https://pubmed.ncbi.nlm.nih.gov/19369963" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19369963</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_19">Bairati I, Meyer F, Gélinas M, et al.: Randomized trial of antioxidant vitamins to prevent acute adverse effects of radiation therapy in head and neck cancer patients. J Clin Oncol 23 (24): 5805-13, 2005. [<a href="https://pubmed.ncbi.nlm.nih.gov/16027437" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16027437</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_20">Bairati I, Meyer F, Jobin E, et al.: Antioxidant vitamins supplementation and mortality: a randomized trial in head and neck cancer patients. Int J Cancer 119 (9): 2221-4, 2006. [<a href="https://pubmed.ncbi.nlm.nih.gov/16841333" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 16841333</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_21">Bilgi N, Bell K, Ananthakrishnan AN, et al.: Imatinib and Panax ginseng: a potential interaction resulting in liver toxicity. Ann Pharmacother 44 (5): 926-8, 2010. [<a href="https://pubmed.ncbi.nlm.nih.gov/20332334" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 20332334</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_22">Golden EB, Lam PY, Kardosh A, et al.: Green tea polyphenols block the anticancer effects of bortezomib and other boronic acid-based proteasome inhibitors. Blood 113 (23): 5927-37, 2009. [<a href="https://pubmed.ncbi.nlm.nih.gov/19190249" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19190249</span></a>]</div></li><li><div class="bk_ref" id="CDR0000799261_rl_88_23">Bannerman B, Xu L, Jones M, et al.: Preclinical evaluation of the antitumor activity of bortezomib in combination with vitamin C or with epigallocatechin gallate, a component of green tea. Cancer Chemother Pharmacol 68 (5): 1145-54, 2011. [<a href="/pmc/articles/PMC3215871/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC3215871</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/21400028" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 21400028</span></a>]</div></li></ol></div></div><div id="CDR0000799261__5"><h2 id="_CDR0000799261__5_">Changes to This Summary (06/10/2021)</h2><p id="CDR0000799261__6">The PDQ cancer information summaries are reviewed regularly and updated as
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new information becomes available. This section describes the latest
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changes made to this summary as of the date above.</p><p id="CDR0000799261__168">This summary was renamed from Foods, Dietary Supplements, and Cancer Therapy Interactions.</p><p id="CDR0000799261__165"><b><a href="#CDR0000799261__1">General Information</a></b></p><p id="CDR0000799261__166">Added <a href="#CDR0000799261__164">text</a> to state that in the United States, dietary supplements are regulated as foods, not drugs. Therefore, premarket evaluation and approval of such supplements by the U.S. Food and Drug Administration (FDA) are not required unless specific disease prevention or treatment claims are made. Because dietary supplements are not formally reviewed for manufacturing consistency, ingredients may vary considerably from lot to lot and there is no guarantee that ingredients claimed on product labels are present (or are present in the specified amounts). The FDA has not approved the use of dietary supplements as a treatment for cancer patients.</p><p id="CDR0000799261__167">Added Jung et al. as <a href="#CDR0000799261__185">reference 5</a>. Also added that a similar study investigated the outcomes for breast cancer patients using antioxidant supplements before and during treatment with cyclophosphamide, doxorubicin, and paclitaxel. The results showed an increase in hazards of recurrence and death in these patients. Though these hazard ratios are not statistically significant, they both trended in the same direction as those seen in the previous study (cited Ambrosone et al. as reference 9).</p><p id="CDR0000799261__169"><b><a href="#CDR0000799261__107">Herbs</a></b></p><p id="CDR0000799261__170">Added this new section title.</p><p id="CDR0000799261__171"><b><a href="#CDR0000799261__140">Foods</a></b></p><p id="CDR0000799261__172">Added this new section title.</p><p id="CDR0000799261__disclaimerHP_3">This summary is written and maintained by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/cam" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Integrative, Alternative, and Complementary Therapies Editorial Board</a>, which is
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editorially independent of NCI. The summary reflects an independent review of
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the literature and does not represent a policy statement of NCI or NIH. More
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information about summary policies and the role of the PDQ Editorial Boards in
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maintaining the PDQ summaries can be found on the <a href="#CDR0000799261__AboutThis_1">About This PDQ Summary</a> and <a href="https://www.cancer.gov/publications/pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ® - NCI's Comprehensive Cancer Database</a> pages.
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</p></div><div id="CDR0000799261__AboutThis_1"><h2 id="_CDR0000799261__AboutThis_1_">About This PDQ Summary</h2><div id="CDR0000799261__AboutThis_2"><h3>Purpose of This Summary</h3><p id="CDR0000799261__AboutThis_3">This PDQ cancer information summary for health professionals provides comprehensive, peer-reviewed, evidence-based information about cancer therapy interactions with foods and dietary supplements in people with cancer.. It is intended as a resource to inform and assist clinicians who care for cancer patients. It does not provide formal guidelines or recommendations for making health care decisions.</p></div><div id="CDR0000799261__AboutThis_4"><h3>Reviewers and Updates</h3><p id="CDR0000799261__AboutThis_5">This summary is reviewed regularly and updated as necessary by the <a href="https://www.cancer.gov/publications/pdq/editorial-boards/cam" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">PDQ Integrative, Alternative, and Complementary Therapies Editorial Board</a>, which is editorially independent of the National Cancer Institute (NCI). The summary reflects an independent review of the literature and does not represent a policy statement of NCI or the National Institutes of Health (NIH).</p><p id="CDR0000799261__AboutThis_22"> Board members review recently published articles each month to determine whether an article should:</p><ul id="CDR0000799261__AboutThis_6"><li class="half_rhythm"><div>be discussed at a meeting,</div></li><li class="half_rhythm"><div>be cited with text, or</div></li><li class="half_rhythm"><div>replace or update an existing article that is already cited.</div></li></ul><p id="CDR0000799261__AboutThis_7">Changes to the summaries are made through a consensus process in which Board members evaluate the strength of the evidence in the published articles and determine how the article should be included in the summary.</p><p id="CDR0000799261__AboutThis_9">Any comments or questions about the summary content should be submitted to Cancer.gov through the NCI website's <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>. Do not contact the individual Board Members with questions or comments about the summaries. Board members will not respond to individual inquiries.</p></div><div id="CDR0000799261__AboutThis_10"><h3>Levels of Evidence</h3><p id="CDR0000799261__AboutThis_11">Some of the reference citations in this summary are accompanied by a level-of-evidence designation. These designations are intended to help readers assess the strength of the evidence supporting the use of specific interventions or approaches. The PDQ Integrative, Alternative, and Complementary Therapies Editorial Board uses a <a href="/books/n/pdqcis/CDR0000256874/">formal evidence ranking system</a> in developing its level-of-evidence designations.</p></div><div id="CDR0000799261__AboutThis_12"><h3>Permission to Use This Summary</h3><p id="CDR0000799261__AboutThis_13">PDQ is a registered trademark. Although the content of PDQ documents can be used freely as text, it cannot be identified as an NCI PDQ cancer information summary unless it is presented in its entirety and is regularly updated. However, an author would be permitted to write a sentence such as “NCI’s PDQ cancer information summary about breast cancer prevention states the risks succinctly: [include excerpt from the summary].”</p><p id="CDR0000799261__AboutThis_14">The preferred citation for this PDQ summary is:</p><p id="CDR0000799261__AboutThis_15">PDQ® Integrative, Alternative, and Complementary Therapies Editorial Board. PDQ Cancer Therapy Interactions With Foods and Dietary Supplements. Bethesda, MD: National Cancer Institute. Updated <MM/DD/YYYY>. Available at: <a href="https://www.cancer.gov/about-cancer/treatment/cam/hp/dietary-interactions-pdq" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">https://www.cancer.gov/about-cancer/treatment/cam/hp/dietary-interactions-pdq</a>. Accessed <MM/DD/YYYY>. [PMID: 33079503]</p><p id="CDR0000799261__AboutThis_16">Images in this summary are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in this summary, along with many other cancer-related images, is available in <a href="https://visualsonline.cancer.gov/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Visuals Online</a>, a collection of over 2,000 scientific images.
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</p></div><div id="CDR0000799261__AboutThis_17"><h3>Disclaimer</h3><p id="CDR0000799261__AboutThis_19">The information in these summaries should not be used as a basis for insurance reimbursement determinations. More information on insurance coverage is available on Cancer.gov on the <a href="https://www.cancer.gov/about-cancer/managing-care" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Managing Cancer Care</a> page.</p></div><div id="CDR0000799261__AboutThis_20"><h3>Contact Us</h3><p id="CDR0000799261__AboutThis_21">More information about contacting us or receiving help with the Cancer.gov website can be found on our <a href="https://www.cancer.gov/contact" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Contact Us for Help</a> page. Questions can also be submitted to Cancer.gov through the website’s <a href="https://www.cancer.gov/contact/email-us" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Email Us</a>.</p></div></div></div></div>
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<div xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance"></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Views</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="PDF_download" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK563071.2/?report=reader">PubReader</a></li><li><a href="/books/NBK563071.2/?report=printable">Print View</a></li><li><a data-jig="ncbidialog" href="#_ncbi_dlg_citbx_NBK563071" data-jigconfig="width:400,modal:true">Cite this Page</a><div id="_ncbi_dlg_citbx_NBK563071" style="display:none" title="Cite this Page"><div class="bk_tt">PDQ Integrative, Alternative, and Complementary Therapies Editorial Board. Cancer Therapy Interactions With Foods and Dietary Supplements (PDQ®): Health Professional Version. 2021 Jun 10. In: PDQ Cancer Information Summaries [Internet]. 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Summary</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related publications</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="document-links" id="Shutter"></a></div><div class="portlet_content"><ul xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="simple-list"><li><a href="/books/NBK572880/">Patient Version</a></li></ul></div></div><div class="portlet"><div class="portlet_head"><div class="portlet_title"><h3><span>Related information</span></h3></div><a name="Shutter" sid="1" href="#" class="portlet_shutter" title="Show/hide content" remembercollapsed="true" pgsec_name="discovery_db_links" id="Shutter"></a></div><div class="portlet_content"><ul><li class="brieflinkpopper"><a class="brieflinkpopperctrl" 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xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Intravenous Vitamin C (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Intravenous Vitamin C (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Integrative, Alternative, and Complementary Therapies Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="cit">PDQ Cancer Information Summaries. 2002</em></div></div></li><li class="brieflinkpopper two_line"><a class="brieflinkpopperctrl" href="/pubmed/26389506" ref="ordinalpos=1&linkpos=2&log$=relatedreviews&logdbfrom=pubmed"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Topics in Integrative, Alternative, and Complementary Therapies (PDQ®): Health Professional Version.</a><span class="source">[PDQ Cancer Information Summari...]</span><div class="brieflinkpop offscreen_noflow"><span xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="invert">Review</span> Topics in Integrative, Alternative, and Complementary Therapies (PDQ®): Health Professional Version.<div class="brieflinkpopdesc"><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" class="author">PDQ Integrative, Alternative, and Complementary Therapies Editorial Board. </em><em xmlns:np="http://ncbi.gov/portal/XSLT/namespace" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" 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