Milk vetch (Astragalus mongholicus)

Systematic reviews and meta-analyses

The Cochrane Collaboration performed a review on Chinese medical herbs for chemotherapy side effects in colorectal cancer patients. They evaluated the Cochrane library, Medline, Embase, CBM and manually searched relevant Chinese journals, and could only find four relevant trials which were all of low quality. These trials all used a decoction with Huangqi as the active ingredient, which is prepared from the dried root of Astragalus membranaceus and Astragalus mongholicus. These studies suggested stimulation of immunocompetent cells and a decrease in chemotherapy-related side effects in patients with colorectal cancer. The Cochrane Collaboration found no harmful effects associated with the use of Chinese herbs. High quality randomized controlled trials (RCTs) were recommended 15.

Wu et al. conducted a systematic review and meta-analyses of Traditional Chinese Medicines for the treatment of hepatocellular cancers. They included 45 RCTs, all performed in China, but they noted that randomization of trials performed in China was questionable, and that a publication bias for positive results was highly likely. Despite this, they found positive results for products containing ginseng, Astragalus and mylabris, and for any products containing Astragalus on all measured outcomes, including complete response, partial response, stable disease, progressive disease, survival rates and symptom improvement. The authors suggested that these results should be evaluated in high-quality and transparent clinical trials 16.

The result of a meta-analysis of randomized trials with Astragalus-based Chinese herbs and Platinum-based chemotherapy for advanced non-small-cell lung cancer indicates that Astragalus-based Chinese herbal medicine may increase the effectiveness of platinum-based chemotherapy. Despite the positive outcome of the included trials, the authors emphasized that no definitive conclusions could be made due to the poor quality of the trials 17.

Molassiotis et al. reviewed the effectiveness of Chinese herbal medication in symptom management and improvement of quality of life in adult cancer patients. Noteworthy are two trials that solely used Astragalus. The first one was a randomized control trial where Astragalus was injected (40g per day) in 60 patients for four cycles of 21 days. They found a significant increase in CD4/CD8 ratio, IgG and IgM and Karnofsky Performance status in the treatment group compared to the control group (also 60 patients). The other trial discussed in the review was a prospective quasi-experimental study of 30 patients (with 30 patients in a control group). One-hundred-and-twenty grams of Astragalus was administered intravenously daily starting 3 days prior to chemotherapy until completion of chemotherapy treatment. There was a significant increase in remission time, median survival time and 1-year survival time. There was significant difference in 2- and 3-year survival time between the treatment and control group 28.

Clinical trials

Twenty-four non-small-cell lung cancer patients were enrolled in a safety and pharmacokinetic trial of docetaxel with an Astragalus-based herbal formula called “Jinfukang”. Twenty-one patients started Jinfukang and docetaxel. The study could not demonstrate an alteration in the pharmacokinetics of Docetaxel and did not show a reduction in serious side effects 18.

An extract from Astragalus induced a restored immune reaction in 9 of 10 patients with a significant increase in local graft versus host (GVH) reaction (P<0.01). This suggested that Astragalus contains potent immune stimulants. This was evaluated in 19 cancer patients and 15 normal healthy controls. Circulating mononuclear cells were isolated from heparinized peripheral venous blood, half of which were treated with Astragalus extract; the treated and untreated cells were then injected in partially immunosuppressed rats. Local GVH reaction was used as an outcome of a boosted immune reaction 7.

Case series/studies

Resolution of pain and other cancer outcomes were evaluated in patients with different types of cancers by mechanical treatments in combination with DHEA, Astragalus and Boswellia serrata. These experimental cases were however of very poor quality, and employed questionable methods. No conclusions can be drawn from this article 19.

Pre-clinical trials

The immunomodulating and immunorestorative activities of the Astragalus membranaceus fraction that displayed the highest mitogenic activities were successfully examined both in vitro and in vivo. It was demonstrated that the depressed immune functions in tumor bearing mice and cyclophosphamide-treated mice could be partially restored 1-4,20-27.