Herbal Approaches to Cholangiocarcinoma: A Systematic Review

Cholangiocarcinoma (CCA) is a malignant bile duct cancer of epithelial cells with high morbidity and mortality. The growing incidence of cholangiocarcinoma (bile duct cancer) and limited treatment options stimulate a pressing demand for research and the development of new chemotherapeutics against cholangiocarcinoma. This chapter highlights the role of herbal medicine in Cholangiocarcinoma control by using a systematic review approach. This study also aimed to systematically review herbs and herb-derived compounds or herbal formulations that have been investigated for their anti-cholangiocarcinoma potential. Systematic literature searches were conducted in three electronic databases: PubMed, Science Direct, and Scopus. The studies were initially screened by titles and abstracts to exclude irrelevant articles and duplication. One hundred and twenty-three research articles fulfilled the eligibility criteria and were included in the analysis (68 herbs, isolated compounds and/or synthetic analogs, 9 herbal formulations, and 119 compounds that are commonly found in several plant species). The most investigated herb was Atractylodes lancea (Thunb.) DC. (Compositae) and Curcuma longa L. (Zingiberaceae). Only A. lancea (Thunb.) DC. (Compositae) has undergone the full process of nonclinical and clinical develop- ment to deliver the final product for clinical use. The extracts of A. lancea (Thunb.) DC. (Compositae), Garcinia hanburyi Hook.f. (Clusiaceae), and Piper nigrum L. (Piperaceae) exhibit antiproliferative activities against human cholangiocarcinoma cells (IC50 < 15 µg/mL). Cucurbitacin B and triptolide are herbal isolated compounds that exhibit the most promising activities (IC50 < 1 µM). A series of experimental studies (in vitro, in vivo, and humans) confirmed the anti-cholangiocarcinoma potential and safety profile of A. lancea (Thunb.) DC. (Compositae) and its active compounds atractylodin and
- eudesmol, including the capsule pharmaceutical of the standardized A. lancea (Thunb.) DC. (Compositae) extract. Future research should focus on the full development of the candidate herbs to deliver safe and effective products for cholangiocarcinoma control.

Future research should be geared toward the full development of the candidate herbs until the delivery of final products that are safe and effective for CCA control.