Effects of the Chinese herbal medicine Hong Huang decoction, on myocardial injury in breast cancer patients who underwent anthracycline-based chemotherapy

ObjectiveTo assess the effects of Hong Huang Decoction (HHD), a Chinese herbal medicine, on myocardial injury in breast cancer patients who underwent anthracycline (ANT)-based chemotherapy. MethodsA total of 51 patients with breast cancer who underwent an ANT-based chemotherapy program and met the inclusion/exclusion criteria were allocated to the treatment or placebo groups using a random number generation process. Patients in the treatment group received liquid HHD twice a day. Treatment was given from 1 day prior to chemotherapy up to the end of chemotherapy (after 6 months). Participants in the placebo group received a placebo over the same schedule. Left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), diagnostic markers of acute myocardial infarction [e.g., lactate dehydrogenase (LDH), creatine kinase-MB (CK-MB), and B-type natriuretic peptide (BNP)], nitric oxide (NO), superoxide dismutase (SOD), as well as pro-inflammatory cytokines [e.g., tumor necrosis factor-alpha (TNF-alpha), interleukin-6 (IL-6), and human C-reactive protein (CRP)], and anti-inflammatory cytokine interleukin-10 (IL-10), were outcome measures assessed before chemotherapy, 3 and 6 months after chemotherapy. ResultsCompared to the placebo group, the GLS value was significantly higher in the treatment group (19.95 +/- 1.16 vs. 19.06 +/- 1.64, P <= 0.001). Significant differences were also noted for levels of SOD (689.71 +/- 203.60 vs. 807.88 +/- 182.10, P < 0.05), IL-6 (58.04 +/- 22.06 vs. 194.20 +/- 40.14, P <= 0.001), IL-10 (237.90 +/- 94.98 vs. 68.81 +/- 32.92, P <= 0.001), NO (75.05 +/- 26.39 vs. 55.83 +/- 19.37, P <= 0.005), and TNF-alpha (301.80 +/- 134.20 vs. 680.30 +/- 199.60, P <= 0.001) in the patients before chemotherapy compared to 6 months after initiating chemotherapy. ConclusionHHD regulated the levels of IL-6, IL-10, SOD, NO, and TNF-alpha. The results demonstrated that GLS is a better indicator of early myocardial injury compared to LVEF, and HHD could modulate oxidative stress to protect against ANT cardio toxicity.