Silymarin as a preventive or therapeutic measure for chemotherapy and radiotherapy-induced adverse reactions: a comprehensive review of preclinical and clinical data
- 1 December 2022
- journal article
- review article
- Published by Springer Science and Business Media LLC in European Journal of Clinical Pharmacology
- Vol. 79 (1), 15-38
- https://doi.org/10.1007/s00228-022-03434-8
Abstract
Purpose Thus far, silymarin has been examined in several studies for prevention or treatment of various chemotherapy or radiotherapy-induced adverse reactions. In this review, we try to collect all available human, animal, and pre-clinical data in this field. Methods The search was done in Scopus, PubMed, Medline, and systematic reviews in the Cochrane database, using the following keywords: “Cancer,” “Chemotherapy,” “Radiotherapy,” “Mucositis,” “Nephrotoxicity,” “Dermatitis,” “Ototoxicity,” “Cardiotoxicity,” “Nephrotoxicity,” “Hepatotoxicity,” “Reproductive system,” “Silybum marianum,” “Milk thistle,” and “Silymarin” and “Silybin.” We included all relevant in vitro, in vivo, and human studies up to the date of publication. Results Based on 64 included studies in this review, silymarin is considered a safe and well-tolerated compound, with no known clinical drug interaction. Notably, multiple adverse reactions of chemotherapeutic agents are effectively managed by its antioxidant, anti-apoptotic, anti-inflammatory, and anti-immunomodulatory properties. Clinical trials suggest that oral silymarin may be a promising adjuvant with cancer treatments, particularly against hepatotoxicity (n = 10), nephrotoxicity (n = 3), diarrhea (n = 1), and mucositis (n = 3), whereas its topical formulation can be particularly effective against radiodermatitis (n = 2) and hand-foot syndrome (HFS) (n = 1). Conclusion Further studies are required to determine the optimal dose, duration, and the best formulation of silymarin to prevent and/or manage chemotherapy and radiotherapy-induced complications.Keywords
This publication has 96 references indexed in Scilit:
- Blood Levels of Glial Fibrillary Acidic Protein (GFAP) in Patients with Neurological DiseasesPLOS ONE, 2013
- Chemotherapy-Associated Liver Injury in Patients with Colorectal Liver Metastases: A Systematic Review and Meta-analysisAnnals of Surgical Oncology, 2012
- Silybum marianum(milk thistle) in the management and prevention of hepatotoxicity in a patient undergoing reinduction therapy for acute myelogenous leukemiaJournal of Oncology Pharmacy Practice, 2012
- The Protective Effects of Silymarin against Doxorubicin-Induced Cardiotoxicity and Hepatotoxicity in RatsMolecules, 2011
- Silymarin selectively protects human renal cells from cisplatin-induced cell deathPharmaceutical Biology, 2011
- A randomized, controlled, double‐blind, pilot study of milk thistle for the treatment of hepatotoxicity in childhood acute lymphoblastic leukemia (ALL)Cancer, 2009
- Multitargeted therapy of cancer by silymarinCancer Letters, 2008
- Silymarin prevents adriamycin-induced cardiotoxicity and nephrotoxicity in ratsFood and Chemical Toxicology, 2008
- Prevention and Treatment of Acute Radiation Dermatitis: A Literature ReviewOncology Nursing Forum, 2004
- Influence of silymarin and its flavonolignans on doxorubicin-iron induced lipid peroxidation in rat heart microsomes and mitochondria in comparison with quercetinPhytotherapy Research, 2002