Oral mucositis is one of the main adverse events of cancer treatment with chemotherapy or radiation therapy. Presenting as redness and ulceration of the oral mucosa, oral mucositis is a painful complication that causes difficulty swallowing, alterations in taste, weight loss, and secondary infections. These complications can significantly complicate and delay treatment, extend hospital stays and decrease quality of life for patients.1 Few therapeutic options are available for mucositis prevention or treatment, most with poor effectiveness.2
The Ayurvedic herb, Tinospora cordifolia (Tinospora) may be an option to assist with these patient symptoms. As a radioprotector, Tinospora has been shown to reduce the severity of oral mucositis in patients undergoing cancer therapy.3
Oral mucositis - a common complaint for cancer patients
Approximately 30-40% of cancer patients receiving chemotherapy will develop oral mucositis.2 This rises to almost 80% of patients treated with high-dose chemo- and up to 100% of patients receiving radiotherapy for head and neck cancers.1
Incidence and severity can vary depending on the treatment regime, doses and number of cycles. Individual patient characteristics such as older age, female gender, high BMI and genetic susceptibility also affect risk.2
Tinospora supports patients undergoing cancer therapy
A double-blind, randomised, controlled trial evaluated the radioprotective effect of Tinospora in patients undergoing radiotherapy for head and neck cancers.3 Patients were randomly allocated to receive either 20 g/day of Tinospora (in honey) or placebo for eight weeks. Supplementation commenced 15 days prior to administration of radiotherapy and was discontinued at the end of radiotherapy treatment.
The effectiveness of Tinospora was evaluated by a) grading oral mucositis as per WHO standards and b) measuring whole stimulated saliva (WSS). These were recorded before and after radiotherapy. Declines in saliva reflect radiation-provoked inflammatory and degenerative changes of the salivary glands.
Tinospora treatment resulted in statistically significant decreases in the severity of mucositis, as well as statistically significant improvements in WSS (i.e. less saliva volume loss in Tinospora patients), compared to the controls.3
Tinospora targets multiple drivers
Mucositis development is a multistep process. Reactive oxygen species (ROS), as an early driver of mucosal damage, represents a potential target for the inhibition of mucositis development.2 Researchers consider Tinospora’s direct antioxidant mechanisms may help ameliorate radiation-induced oxidative stress.3 Inflammation is also deeply entrenched in the disease process. Impairing the action of NF-kB as the main mediator of mucositis, could also affect condition development.2
Tinospora is widely used in Ayurvedic medicine for its tonic, anti-inflammatory, antioxidant, immunomodulator, adaptogenic, anti-ageing, and antiulcer properties.3 The herb is used in ‘rasayanas’ to improve the immune system and the body’s resistance to infection.3
These actions combine to support the patient during cancer therapy. In particular, Tinospora’s antioxidant and anti-inflammatory actions target key pathways implicated in the disease process.
Conclusion
The incidence of oral mucositis is high in patients receiving cancer therapy, especially those with head and neck cancers. Tinospora has been found to be an effective radioprotector in patients with head and neck cancer undergoing treatment, significantly decreasing the severity of oral mucositis and reducing loss of salivary secretions. Tinospora may be a valuable option to support patients undergoing cancer treatment and improve their quality of life.
References
1.Daugėlaitė G, Užkuraitytė K, Jagelavičienė E, Filipauskas A. prevention and treatment of chemotherapy and radiotherapy induced oral mucositis. Medicina (Kaunas). 2019 Jan 22;55(2):25.
2. Pulito C, Cristaudo A, Porta C, Zapperi S, Blandino G, Morrone A, Strano S. Oral mucositis: the hidden side of cancer therapy. J Exp Clin Cancer Res. 2020 Oct 7;39(1):210.
3. Amruthesh S. Evaluation of radioprotective effects of Tinospora Cordifolia in patients on radiotherapy for squamous cell carcinoma of the head & neck-a pilot study. IJCD. 2010;1(1):24-30.
