Benefit–risk profile of black cohosh (isopropanolic Cimicifuga racemosa extract) with and without St John’s wort in breast cancer patients

Abstract

Endocrine therapy in breast cancer survivors can cause severe 'climacteric' symptoms, which may compromise therapy adherence. To determine whether such symptoms can be treated with herbal medication containing black cohosh in the form of isopropanolic Cimicifuga racemosa extract (iCR) alone or in fixed combination with St John's wort (Hypericum perforatum [HP]) (iCR þ HP), a systematic literature search was conducted. Results were viewed in relation to experimental data and metabolism of endocrine therapies. Most breast cancer survivors receiving endocrine therapy experienced reductions in climacteric symptoms under iCR/iCR þ HP. Tamoxifen's interference potential may be countered by using higher iCR doses or iCR þ HP. No estrogen-like effects at the breast or on hormones were seen. After breast cancer, even if receiving tamoxifen, patients using iCR/iCR þ HP had significantly increased recurrence-free survival rates compared to non-users. These results are substantiated by experimental data demonstrating antiproliferative and anti-invasive effects of iCR in breast cancer cells and enhancement of the antineoplastic effects of tamoxifen. There are no known clinical interactions for iCR and HP with endocrine therapies. The HP extract used in iCR þ HP did not exhibit any clinically relevant interaction potential. In conclusion, with its positive benefit-risk profile, iCR/iCR þ HP may offer a safe non-hormonal therapeutic option for breast cancer survivors receiving endocrine therapy.

<p>Menopausal Symptoms and Associated Social and Environmental Factors in Midlife Chinese Women</p>

“…About this, we have published elsewhere. 38 Regarding a possible association between menopausal symptoms and other related factors, which were investigated in our study, we found that current smoking, gravidity, parity, and menarche are not related to menopausal symptoms. We only found that alcohol consumption (≥3times/week) could aggravate VMS.…”

“…This is in line with the results of Freeman et al, who found a significant positive association between alcohol intake and hot flashes. 38 However, the results in the SWAN study did not detect any effects of alcohol consumption on VMS. 39 This and other differences can be explained as we performed simple and unconditional logistic regression methods with rigorous adjustment of all analyzed factors, with the consequence that we obtained similar results to other studies for some of those single factors in the "Crude OR", ie, significant relationships, but not after multiple adjustments.…”

Optimizing care for younger women with hormone receptor‐positive, HER2‐negative metastatic breast cancer

“…53,54 • Specific dietary supplements, such as a fixed combination of black cohosh (isopropanolic Cimicifuga racemosa extract) and St John's wort. 55 • Gabapentin. 54,56,57 • Clonidine.…”

“…54,58,59 • Appropriate selective serotonin reuptake inhibitors (SSRIs; note that some SSRIs, such as paroxetine and fluoxetine, are likely to interfere with the metabolism of tamoxifen, resulting in reduced production of its main active metabolite, and should be avoided when patients are on this ET). 54,55,[58][59][60][61] • Oxybutynin (Table 4). 54,62,63 • Stellate ganglion block (limited supporting study data, but case reports/series indicate that there are some patients for whom nothing else works and for whom this option provides relief).…”

Complementary and Alternative Medicine (CAM) Usage in Breast Cancer

“…However, further studies, especially clinical trials, are required to confirm this. Further recommendations include weight loss (for achieving an effect, 10% decrease in the usual weight is required) and the administration of Cimicifuga racemosa, eventually in combination with St John's Wort in cases with reduced auxiliary mood swings [26].…”