Natural Medicine Journal Oncology Supplement: Vol 9 No 111

Page 10

ABSTRACT & COMMENTARY

Coriolus versicolor in Advanced Hepatocellular Carcinoma Further research warranted

Ellen McDonnell, ND

REFERENCE

KEY FINDINGS

Chay WY, Tham CK, Toh HC, et al. Coriolus versicolor (Yunzhi) use as therapy in advanced hepatocellular carcinoma patients with poor liver function or who are unfit for standard therapy. J Altern Complement Med. 2017;23(8):648-652.

Median treatment duration was 12.1 weeks for CV group and 5.9 weeks for placebo group. Seventy percent of participants terminated treatment due to progressive disease or death, and no difference in treatment tolerability between groups was found.

OBJECTIVE

Disease-related outcomes There were no statistically significant differences in median TTP, PFS, or OS when treatment was compared to placebo: • Median TTP (months): 2.5 (95% confidence interval [CI]: 1.4-5.3) vs 4.2 (95% CI: 0.4-4.2), with an HR of 0.7 (95% CI: 0.16-3.05, P=0.63). • Median PFS (months): 2.5 (95% CI: 1.4-5.3) vs 1.1 (95% CI: 0.4-4.2), with an HR of 0.42 (95% CI: 0.13-1.34, P=0.144) • Median OS (months): 6.5 (95% CI: 3.3-24.1) vs 2.2 (95% CI: 0.8-23.3) with an HR of 0.35 (95% CI: 0.10-1.25, P=0.105) • Overall response rates: 11.1% (95% CI: 0.3-48.2) vs 16.7% (95% CI: 0.4-64.1%)

To evaluate the impact of Coriolus versicolor (CV) on disease progression, survival, quality of life, and blood markers in individuals with advanced hepatocellular carcinoma. DESIGN

Randomized controlled trial PARTICIPANTS

Fifteen individuals (14 men, 1 woman) of Asian ethnicity aged 48 to 74 with advanced hepatocellular carcinoma (HCC) were randomized 2:1 to receive CV (n=9) or placebo (n=6). Participants were eligible if they had inoperable HCC and liver cirrhosis (Child-Pugh class C) or HCC with liver cirrhosis (Child-Pugh class A or B) and had failed or were unfit for standard chemotherapy or radiotherapy. STUDY PARAMETERS ASSESSED

Median time to progression (TTP), response rates, toxicity, quality of life (QoL), progression-free survival (PFS), overall survival (OS), correlative analysis of blood markers PRIMARY OUTCOME MEASURES

Median TTP, PFS, and OS, and QoL; TTP, PFS, and OS were analyzed by KaplanMeier, and hazard ratio (HR) was determined by Cox regression analysis. QoL was measured using the Functional Assessment of Cancer Treatment questionnaire for individuals with hepatobiliary cancer (FACT-Hep) and the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30). INTERVENTION

Oral administration of 2.4 g CV daily until disease progression or unacceptable toxicity

Quality of life On the EORTC QLQ-30, the CV group reported significantly lower pain and appetite loss scores compared to placebo, differences of −38.6 (95% CI: −65.5 to −11.8), and −39.7 (95% CI: −64.5 to −15.0), respectively.

No other scores on the EORTC or FACTHep were statistically significantly different. Blood analyses iInterleukin (IL)-17F and monocyte chemoattractant protein (MCP)-1 were reduced, and prolactin and tumor necrosis factor (TNF)related apoptosis-inducing ligand (TRAIL) R1 levels were increased in the CV group compared to placebo at the end of treatment. However, no statistical comparisons were reported.

Alpha-fetoprotein (AFP) levels were not different between groups.

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PRACTICE IMPLICATIONS Hepatocellular carcinoma (HCC) accounts for more than 80% of primary liver tumors. Worldwide, liver cancer is the sixth most common malignancy and second largest cause of cancer-related mortality.1 Although the incidence of HCC is highest in Asia and Africa, rates in North America and Europe have risen in the past 3 decades.1 Over 50% of patients are considered advanced at time of diagnosis,2 and in the United States the 5-year relative survival of liver cancer is only 17%.3 In addition to survival, QoL is an important consideration for individuals with HCC as sleep disturbances, depression, fatigue, malnutrition, anorexia, and pain are commonly reported symptoms.3 Given the high mortality rate associated with HCC and poor quality of life, research into adjunctive treatments is warranted. Mushroom extracts including Cori­ olus versicolor are commonly used in integrative oncology as adjuncts to conventional treatment.4 Coriolus versicolor (also known as Turkey tail, Trametes versicolor, and Yun-Zhi) contains polysaccharides, specifically polysaccharopeptide Krestin (PSK) and polysaccharopeptide (PSP), which are largely responsible for its medicinal benefit.5 As a source of fungal polysaccharides, supplemental Coriolus versicolor extracts are used primarily for their immunomodulating properties.6 Coriolus (continued on page 12)