A research article to be published on September 28, 2009 in the World Journal of Gastroenterology addresses this question. The research team, led by Prof. Zong-fang Li from the Second Affiliated Hospital, School of Medicine, Xi’an Jiaotong University, investigated the effects of Chrysanthemum indicum extract (CIE) on inhibition of proliferation and on apoptosis, and the underlying mechanisms, in a human HCC MHCC97H cell line.

They examined viable rat hepatocytes and human endothelial ECV304 cells by trypan blue exclusion and MTT assay, respectively, as normal controls. The proliferation of MHCC97H cells was determined by MTT assay. The cellular morphology of MHCC97H cells was observed by phase contrast microscopy. Flow cytometry was performed to analyze cell apoptosis with annexin V/propidium iodide (PI), mitochondrial membrane potential with rhodamine 123 and cell cycle with PI in MHCC97H cells. Apoptotic proteins such as cytochrome C, caspase-9, caspase-3 and cell cycle proteins, including P21 and CDK4, were measured by Western blotting.

The results showed CIE inhibited proliferation of MHCC97H cells in a time- and dose-dependent manner without cytotoxicity in rat hepatocytes and human endothelial cells. CIE induced apoptosis of MHCC97H cells in a concentration-dependent manner, as determined by flow cytometry. The apoptosis was accompanied by a decrease in mitochondrial membrane potential, release of cytochrome C and activation of caspase-9 and caspase-3. CIE arrested the cell cycle in the S phase by increasing P21 and decreasing CDK4 protein expression.

The researchers drew a conclusion that CIE exerted a significant apoptotic effect through a mitochondrial pathway and arrested the cell cycle by regulation of cell cycle-related proteins in MHCC97H cells without an effect on normal cells. The cancer-specific selectivity shown in their study suggests that the plant extract could be a promising novel treatment for human cancer.

A UK charity said the tea might help men manage low-risk tumours. Although previous studies have shown benefits from drinking green tea – including some positive findings in relation to prostate cancer, there have been mixed results. In this study, Philadelphia-based researchers tested a compound called Polyphenon E.

They were looking for a number of biomarkers – molecules – including vascular endothelial growth factor (VEGF) and hepatocyte growth factor (HGF) which are indicators of developing cancer. They also looked for prostate specific antigen (PSA) – a protein only found in the prostate. Levels can rise if cancer is present.

Polyphenon E (12 cups of tea)

The study included 26 men, aged 41 to 72 years, who had been diagnosed with prostate cancer and who were scheduled for radical prostate surgery. Patients took four capsules containing Polyphenon E for an average of 34 days, up until the day before surgery – the equivalent of around 12 cups of normally brewed concentrated green tea.

The study found a significant reduction in levels of HGF, VEGF and PSA, with some patients demonstrating reductions of more than 30%.

Dr James Cardelli, from the Feist-Weiller Cancer Center, who led the study, said the compound, which was provided by the company Polyphenon Pharma, “may have the potential to lower the incidence and slow the progression of prostate cancer.” There were only a few reported side effects associated with this study, and liver function remained normal.

Dr Cardelli said: “We think that the use of tea polyphenols alone or in combination with other compounds currently used for cancer therapy should be explored as an approach to prevent cancer progression and recurrence.” “There is reasonably good evidence that many cancers are preventable, and our studies using plant-derived substances support the idea that plant compounds found in a healthy diet can play a role in preventing cancer development and progression.”

Active Surveillance

John Neate, chief executive of the Prostate Cancer Charity, said: “There have been several studies into green tea and its potential benefits, but there is, as yet, no conclusive evidence. “The results of this study do suggest that there is merit in further research into the effects of extracts of green tea, both in relation to its impact on the prevention of prostate cancer and in controlling progression in men already diagnosed with the disease, as was investigated in this instance.”

“These initial positive findings could indicate that green tea could have a place in ‘active surveillance’, where a slow-growing, low risk tumour is monitored for changes and men want to take something which could help keep progression at bay. “Potentially, this could mean completely avoiding, in some cases, any of the more usual medical interventions and their associated side effects.”

The results from the Phase I clinical study, a collaborative research project between M. D. Anderson and Fudan University Cancer Hospital in Shanghai, are reported in the online Early View feature of the journal Cancer. The study marks the first time a formal clinical trial has examined the relationship between huachansu dose and toxicity, although the drug is common in China and approved by the Chinese Food and Drug Administration.

Huachansu is widely used to treat patients with liver, lung, colon and pancreatic cancer at oncology clinics in China. Chinese clinical trials conducted since the 1970s have demonstrated the anti-cancer properties of huachansu, citing total response rates of 10% and 16% observed in patients with advanced hepatocellular carcinoma and lung cancer.

“Studying traditional Chinese medicine such as huachansu is new to American research institutions, which have been skeptical and slow to adopt these complementary treatments. However, it is important to understand its potential role in treating cancer,” says Lorenzo Cohen, Ph.D., one of the paper’s authors and director of the Integrative Medicine Program at M. D. Anderson. “We wanted to apply a Western medicine-based approach to explore the role of the toad venom compound in cancer patients and test if it is possible to deliver a more potent dose without raising toxicities or side effects.”

The clinical trial was conducted at the Fudan University Cancer Hospital while M. D. Anderson provided training and ongoing consultation. The institutions collaboratively designed the trial that was approved by both institutional review boards. M. D. Anderson and Fudan University Cancer Hospital signed a sister institution agreement in 2003, creating a framework for research, educational and clinical collaboration.

The typical dose of huachansu used in China is approximately 15 milliliters of drug per meter squared of body mass (mL/m2). In the study, 15 patients with stage III or IV hepatocellular (liver) carcinoma, nonsmall cell lung cancer or pancreatic cancer received one of five dose levels ranging from 10 mL/m2 up to 90 mL/m2 from January 2005 through July 2006. The treatment was repeated daily for 14 days followed by seven days off (one cycle). After two cycles, most patients received other treatments. Quality control methods were put in place to ensure huachansu of a uniform and consistent lot.

While the dose was up to eight times higher than conventional doses used in China, researchers observed only low toxicities or side effects. Eleven (73%) patients had no toxicities greater than the lowest grade measured. Importantly, no significant cardiac toxicity was observed and no significant changes in cancer-related symptoms occurred. Of the 15 patients who completed the treatment, six hepatocellular carcinoma patients (40%) had stable disease for a median of six months. One patient had a 20% reduction in tumor mass that lasted for more than 11 months.

“Even though we saw no complete or partial response (reduction of disease by 30% or more) it is encouraging that the cancer did not progress in a large set of the hepatocellular carcinoma patients,” says Zhiqiang Meng, principal investigator on the trial and an associate professor and deputy chair of the Department of Integrative Oncology at Fudan University Cancer Hospital, “Previous observations from studies conducted in China have shown that huachansu can inhibit tumor cell growth and improve immunologic function3. These findings, coupled with that knowledge, demonstrate the need for further clinical trials of this promising agent.”

A Phase II clinical trial comparing the effects of huachansu combined with gemcitabine (Gemzar®) to gemcitabine and placebo for patients with advanced pancreatic cancer is under way at the Fudan University Cancer Hospital in collaboration with M. D. Anderson. Both trials are part of the International Center of Traditional Chinese Medicine for Cancer funded by the National Cancer Institute. Anhui Jinchan Biochemistry Company, Ltd., provided the drug for this trial.