Ganoderma lucidum (Reishi mushroom) for cancer treatment

  • Review
  • Intervention

Authors


Abstract

Background

Ganoderma lucidum is a natural medicine that is widely used and recommended by Asian physicians and naturopaths for its supporting effects on immune system. Laboratory research and a handful of preclinical trials have suggested that G. lucidum carries promising anticancer and immunomodulatory properties. The popularity of taking G. lucidum as an alternative medicine has been increasing in cancer patients. However, there is no systematic review that has been conducted to evaluate the actual benefits of G. lucidum in cancer treatment.

Objectives

To evaluate the clinical effects of G. lucidum on long-term survival, tumour response, host immune functions and quality of life in cancer patients, as well as adverse events associated with its use.

Search methods

We searched an extensive set of databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, NIH, AMED, CBM, CNKI, CMCC and VIP Information/Chinese Scientific Journals Database was searched for randomised controlled trials (RCTs) in October 2011. Other strategies used were scanning the references of articles retrieved, handsearching of the International Journal of Medicinal Mushrooms and contact with herbal medicine experts and manufacturers of G. lucidum. For this update we updated the searches in February 2016.

Selection criteria

To be eligible for being included in this review, studies had to be RCTs comparing the efficacy of G. lucidum medications to active or placebo control in patients with cancer that had been diagnosed by pathology. All types and stages of cancer were eligible for inclusion. Trials were not restricted on the basis of language.

Data collection and analysis

Five RCTs met the inclusion criteria and were included in this review. Two independent review authors assessed the methodological quality of individual trials. Common primary outcomes were tumour response evaluated according to the World Health Organization (WHO) criteria, immune function parameters such as natural killer (NK)-cell activity and T-lymphocyte co-receptor subsets, and quality of life measured by the Karnofsky scale score. No trial had recorded long-term survival rates. Associated adverse events were reported in one study. A meta-analysis was performed to pool available data from the primary trials. Results were gauged using relative risks (RR) and standard mean differences (SMD) for dichotomous and continuous data respectively, with a 95% confidence interval (CI).

Main results

The methodological quality of primary studies was generally unsatisfying and the results were reported inadequately in many aspects. Additional information was not available from primary trialists. The meta-analysis results showed that patients who had been given G. lucidum alongside with chemo/radiotherapy were more likely to respond positively compared to chemo/radiotherapy alone (RR 1.50; 95% CI 0.90 to 2.51, P = 0.02). G. lucidum treatment alone did not demonstrate the same regression rate as that seen in combined therapy. The results for host immune function indicators suggested that G. lucidum simultaneously increases the percentage of CD3, CD4 and CD8 by 3.91% (95% CI 1.92% to 5.90%, P < 0.01), 3.05% (95% CI 1.00% to 5.11%, P < 0.01) and 2.02% (95% CI 0.21% to 3.84%, P = 0.03), respectively. In addition, leukocyte, NK-cell activity and CD4/CD8 ratio were marginally elevated. Four studies showed that patients in the G. lucidum group had relatively improved quality of life in comparison to controls. One study recorded minimal side effects, including nausea and insomnia. No significant haematological or hepatological toxicity was reported.

Authors' conclusions

Our review did not find sufficient evidence to justify the use of G. lucidum as a first-line treatment for cancer. It remains uncertain whether G. lucidum helps prolong long-term cancer survival. However, G. lucidum could be administered as an alternative adjunct to conventional treatment in consideration of its potential of enhancing tumour response and stimulating host immunity. G. lucidum was generally well tolerated by most participants with only a scattered number of minor adverse events. No major toxicity was observed across the studies. Although there were few reports of harmful effect of G. lucidum, the use of its extract should be judicious, especially after thorough consideration of cost-benefit and patient preference. Future studies should put emphasis on the improvement in methodological quality and further clinical research on the effect of G. lucidum on cancer long-term survival are needed. An update to this review will be performed every two years.

Plain language summary

G. lucidum (Reishi mushroom) for cancer treatment

There have been an increasing number of patients diagnosed with cancer each year. Certain malignancies have been a major cause of death in some populations. People who have been diagnosed with cancer want to do everything they can to combat the disease, manage its symptoms and cope with the side effects of radio/chemotherapy. Many turn to complementary and alternative medicine. G. lucidum extract is a medication that has been widely used by traditional Chinese medicine (TCM) practitioners for this regard. It is usually recommended as an immune system support supplement in cancer treatment. Latest laboratory research and preclinical trials of G. lucidum have shown promising results of its antitumour activity. However, clinical evidence of its efficacy is sparse and a systematic review is in need to provide collective information for health-care consumers.

Our review identified and subsequently included five relevant randomised controlled trials. A total of 373 subjects were analysed. A meta-analysis was performed to pool available data from individual trials. Our results found that patients with G. lucidum extract in their anticancer regimen were 1.27 times more likely to respond to chemotherapy or radiotherapy than those without. However, the data failed to demonstrate significant effect on tumour shrinkage when it was used alone. In addition, G. lucidum could stimulate host immune functions by considerably increasing CD3, CD4 and CD8 lymphocyte percentages. Nevertheless, natural killer (NK)-cell activity, which has been suggested to be an indicator of self-defence against tumour cell, was marginally elevated. Patients in the G. lucidum group were found to have a relatively better quality of life after treatment than those in the control group. A few cases of minor side effect associated with G. lucidum treatment including nausea and insomnia were reported.

There are limitations of the results from this systematic review. First, most included studies were small and there were concerns on the methodological quality of individual trials. Second, all participants in the individual trials were recruited from the Chinese population. Together, the robustness and applicability of the results were largely affected.

Резюме на простом языке

G. Lucidum (гриб Рейши) для лечения рака

Каждый год число пациентов с диагнозом рак становится всё больше. Некоторые злокачественные опухоли стали одной из основных причин смерти в некоторых группах населения. Люди, которым был поставлен диагноз рак, хотят сделать все возможное для борьбы с этим заболеванием, управлять своими симптомами и справляться с побочными эффектами радио / химиотерапии. Многие обращаются к дополнительной и альтернативной медицине. G. Lucidum - экстракт представляет собой препарат, который широко используется в практике традиционной китайской медицины (ТКМ) с этой целью. Его обычно рекомендуют в качестве дополнительной поддержки иммунной системы при лечении рака. Последние лабораторные исследования и доклинические испытания G. Lucidum показали обнадеживающие результаты по его противоопухолевой активности. Однако, клинические доказательства его эффективности разрознены, и необходим систематический обзор, чтобы предоставить целостную информацию для потребителей помощи здравоохранения.

Наш обзор выявил, а затем включил пять соответствующих рандомизированных контролируемых испытаний. В общей сложности 373 человека были проанализированы. Мета-анализ был проведен с целью объединения имеющихся данных из отдельных исследований. Наши результаты нашли, что пациенты, получавшие экстракт G. lucidum в составе противоопухолевого режима терапии, имели в 1,27 раза большую вероятность ответить на химиотерапию или лучевую терапию, чем пациенты, не получавшие экстракта. Однако, эти данные не смогли продемонстрировать значительное влияние на уменьшение размеров опухоли, когда экстракт был использован в монотерапии. В дополнение, G. Lucidum может стимулировать иммунные функции у принимающих его за счет значительного увеличения процентного соотношения CD3, CD4 и CD8 лимфоцитов. Тем не менее, активность естественных клеток-киллеров - (NK)-клеткок, которая, как было предложено, является индикатором собственной защиты против опухолевых клеток, была незначительно повышена. Было показано, что пациенты в группе G. Lucidum имели относительно лучшее качество жизни после лечения, чем в контрольной группе. Сообщалось о нескольких случаях незначительных побочных эффектов, связанных с лечением G. Lucidum , включая тошноту и бессонницу.

Есть ограничения результатов этого систематического обзора. Во-первых, большинство включенных исследований были небольшими, и были опасения по качеству методологии отдельных испытаний. Во-вторых, все участники в отдельных клинических испытаниях были набраны из китайской популяции. На основе совокупности этих факторов, надежность и применимость этих результатов снижаются в значительной степени.

Заметки по переводу

Перевод: Масалбекова Аида Азизбековна. Редактирование: Зиганшина Лилия Евгеньевна. Координация проекта по переводу на русский язык: Cochrane Russia - Кокрейн Россия (филиал Северного Кокрейновского Центра на базе Казанского федерального университета). По вопросам, связанным с этим переводом, пожалуйста, обращайтесь к нам по адресу: lezign@gmail.com

Laienverständliche Zusammenfassung

G. lucidum (Reishi-Pilz, Glänzender Lackporling) zur Krebsbehandlung

Jedes Jahr wird bei einer steigenden Zahl von Menschen Krebs diagnostiziert. In manchen Ländern sind bestimmte bösartige Tumore eine der Haupttodesursachen. Menschen mit der Diagnose Krebs möchten alles ihnen nur Mögliche tun, um die Krankheit zu bekämpfen, ihre Symptome zu lindern und mit den Nebenwirkungen der Strahlen-/Chemotherapie fertig zu werden. Viele von ihnen wenden sich der Komplementär- und Alternativmedizin zu. G. lucidum -Extrakt ist ein medizinisches Heilmittel, das in der traditionellen chinesischen Medizin (TCM) häufig gegen diese Krankheit eingesetzt wird. Gewöhnlich wird es als Ergänzung zur Unterstützung des Immunsystems während einer Krebstherapie empfohlen. Jüngste Laborforschung und präklinische Studien zu G. lucidum ergaben vielversprechende Ergebnisse in Bezug auf dessen Antitumorwirkung. Allerdings liegt nur spärliche klinische Evidenz zu seiner Wirksamkeit vor, und es wäre ein systematischer Review erforderlich, um Verbrauchern von Gesundheitsprodukten umfassende Informationen zu geben.

Für den Review konnten wir fünf einschlägige randomisierte kontrollierte Studien finden und einschließen. Insgesamt wurden 373 Personen analysiert. Um die verfügbaren Daten aus einzelnen Studien zusammenzuführen, wurde eine Metaanalyse durchgeführt. Aus den Ergebnissen ergab sich, dass Patienten, die G. lucidum -Extrakt im Rahmen ihrer Anti-Krebs-Diät verwendeten, mit 1,27-fach höherer Wahrscheinlichkeit auf Chemotherapie oder Strahlentherapie ansprachen, als Patienten ohne diesen Extrakt. Allerdings konnten die Daten keine signifikante Wirkung zur Tumorschrumpfung nachweisen, wenn nur mit G. lucidum therapiert wurde. Darüber hinaus konnte G. lucidum die Immunantwort des Wirtes stimulieren, indem der Anteil an CD3, CD4 und CD8 T-Lymphozyten jeweils erheblich erhöht wurde. Die NK-Zellaktivität (Aktivität der natürlichen Killerzellen), die als Indikator für die Verteidigung des Körpers gegen Tumorzellen gilt, war geringfügig erhöht. Patienten der G. lucidum G. lucidum -Gruppe hatten nach der Behandlung eine vergleichsweise etwas bessere Lebensqualität als Patienten der Kontrollgruppe. Es gab einzelne Fälle von leichten Nebenwirkungen wie Übelkeit und Schlaflosigkeit, die auf die Behandlung mit G. lucidum -Extrakt zurückzuführen waren.

Die Ergebnisse aus diesem systematischen Review sind mit Einschränkungen zu betrachten. Erstens waren die berücksichtigten Studien meist klein, und es gab Bedenken zur methodischen Qualität einzelner Studien. Zweitens gehörten alle Teilnehmer an den einzelnen Studien der chinesischen Bevölkerung an. Diese beiden Faktoren beeinträchtigen erheblich die Robustheit und Übertragbarkeit der Ergebnisse.

Anmerkungen zur Übersetzung

B. Bayerlein, freigegeben durch Cochrane Schweiz.

Laički sažetak

Ganoderma lucidum (Reishi gljiva) za liječenje karcinoma

Svake godine se karcinom (rak) dijagnosticira u sve većeg broja ljudi. Neki tipovi raka postali su glavni uzrok smrti u nekim populacijama. Ljudi kojima je dijagnosticiran rak žele napraviti sve što mogu da bi se izliječila bolest te ublažili simptomi i nuspojave radioterapije i kemoterapije. Mnogi od njih se okreću tzv. komplementarnoj i alternativnoj medicini. Ganoderma lucidum (Reishi gljiva) je gljiva čiji se ekstrakt naveliko koristi u tradicionalnoj kineskoj medicini upravo u tu svrhu. Često se preporučuje kao dodatak za jačanje imunološkoga sustava u sklopu liječenja raka. Novija laboratorijska i pretklinička istraživanja (na životinjama) te gljive G. lucidum su pokazala obećavajuće rezultate njezina djelovanja protiv tumora. Međutim, dokazi njezine učinkovitosti na ljudima su malobrojni i potrebno je provesti sustavni pregled literature kako bi se prikupili i istražili dokazi o djelotvornosti i sigurnosti takve terapije.

Ovaj Cochrane sustavni pregled literature je nakon analize literature uključio pet randomiziranh kontroliranih pokusa na tu temu. U tim istraživanjima sudjelovale su 373 osobe. Statistička analiza podataka (metaanaliza) je napravljena da bi se zajedno analizirali podatci svih zasebnih istraživanja. Rezultati su pokazali da su pacijenti koji su koristili ekstrakt G. Lucidum gljive u svojemu liječenju raka imali 1,27 put bolju reakciju na kemoterapiju ili radioterapiju nego oni koji nisu primali taj ekstrakt. Međutim, analiza podataka nije uspjela pokazati značajan utjecaj na smanjenje tumora kada se ekstrakt gljive primijenio sam. Osim toga, G. lucidum bi mogla stimulirati imunološki sustav pacijenta znatno povećavajući postotak određenih vrsta limfocita u krvi (CD3, CD4 i CD8 limfociti). S druge strane, broj NK stanica (prirodnoubilačke stanice) koje se smatraju pokazateljem nečijeg obrambenog mehanizma bio je samo neznatno povećan. Pacijenti koji su uzimali G. lucidum opisali su nešto bolju kvalitetu života nakon toga načina liječenja, nego oni koji nisu koristili takvu terapiju (kontrolna skupina). Nuspojave korištenja G. lucidum bile su malobrojne, a uključuju mučninu i nesanicu.

Postoje ograničenja u rezultatima ovoga sustavnoga pregleda. Kao prvo, većina uključenih istraživanja bila je mala (uključen malen broj ispitanika) i postojala je sumnja vezana za kvalitetu provedbe pojedinačnih istraživanja. Kao drugo, sudionici tih istraživanja bili su isključivo kineske populacije. Zajedno to bitno utječe na pouzdanost i primjenjivost rezultata tih istraživanja.

Bilješke prijevoda

Hrvatski Cochrane
Prevela: Ivana Križanac
Ovaj sažetak preveden je u okviru volonterskog projekta prevođenja Cochrane sažetaka. Uključite se u projekt i pomozite nam u prevođenju brojnih preostalih Cochrane sažetaka koji su još uvijek dostupni samo na engleskom jeziku. Kontakt: cochrane_croatia@mefst.hr

Ringkasan bahasa mudah

G. lucidum (cendawan Reishi) untuk rawatan kanser

Terdapat peningkatan bilangan pesakit yang didiagnosis dengan kanser setiap tahun. Sesetengah kemalignanan telah menjadi penyebab utama kematian dalam beberapa populasi. Orang yang telah didiagnos dengan kanser mahu melakukan segala yang mereka mampu untuk memerangi penyakit ini, menguruskan gejala dan menangani kesan sampingan radio/ kemoterapi. Kebanyakkan beralih kepada perubatan komplemantari dan alternatif. Ekstrak G. lucidum adalah ubat yang digunakan secara meluas oleh pengamal perubatan tradisional Cina (TCM) untuk hal ini. Ia sering disyorkan sebagai penambah sokongan sistem imun dalam rawatan kanser. Penyelidikan makmal terkini dan kajian prelinikal G. lucidum telah menunjukkan keputusan aktiviti antitumour yang berpotensi. Namun, bukti klinikal keberkesanannya adalah kurang dan ulasan sistematik diperlukan untuk menyediakan maklumat kolektif untuk pengguna penjagaan kesihatan.

Ulasan kami mengenal pasti dan seterusnya memasukkan lima kajian rawak terkawal yang relevan. Sejumlah 373 subjek dianalisis. Analisis meta dilakukan untuk mengumpul data sedia ada dari kajian-kajian individu. Keputusan kami mendapati pesakit dengan ekstrak G. lucidum dalam regimen antikanser mereka adalah 1.27 kali lebih berkemungkinan untuk respon kepada kemoterapi atau radioterapi daripada mereka yang tanpanya. Namun, data gagal menunjukkan kesan yang ketara terhadap pengecutan tumor apabila digunakan secara bersendirian. Di samping itu, G. lucidum dapat merangsang fungsi imun perumah dengan meningkatkan peratusan limfosit CD3, CD4 dan CD8. Namun, aktiviti pembunuh semulajadi (NK) yang dicadangkan untuk menjadi penunjuk pertahanan diri terhadap sel tumor, meningkat sedikit. Pesakit dalam kumpulan G. lucidum didapati mempunyai kualiti hidup yang lebih baik selepas rawatan berbanding kumpulan kawalan. Beberapa kes kesan sampingan kecil yang berkaitan dengan rawatan G. lucidum termasuklah mual dan insomnia dilaporkan.

Terdapat batasan dalam keputusan ulasan sistematik ini. Pertama, kebanyakan kajian yang dimasukkan adalah kecil dan terdapat kebimbangan tentang kualiti metodologi kajian-kajian individu. Kedua, semua peserta dalam kajian-kajian individu adalah direkrut dari populasi China. Secara keseluruhan, keteguhan dan kebolehgunaan keputusan telah terjejas.

Catatan terjemahan

Diterjemahkan oleh Wong Chun Hoong (International Medical University). Disunting oleh Noorliza Mastura Ismail (Kolej Perubatan Melaka-Manipal). Untuk sebarang pertanyaan berkaitan terjemahan ini sila hubungi Wong.ChunHoong@student.imu.edu.my.

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