Traditional Chinese medicine in lung cancer treatment

Abstract

Lung cancer remains a major global health challenge and one of the leading causes of cancer-related deaths worldwide. Despite significant advancements in treatment, challenges such as drug resistance, side effects, metastasis and recurrence continue to impact patient outcomes and quality of life. In response, there is growing interest in complementary and integrative approaches to cancer care. Traditional Chinese medicine (TCM), with its long history, abundant clinical experience, holistic perspective and individualized approach, has garnered increasing attention for its role in lung cancer prevention and management. This review provides a comprehensive overview of the advances in TCM for lung cancer treatment, covering its theoretical foundation, treatment principles, clinical experiences and evidence supporting its efficacy. We also provide a systematic summary of the preclinical mechanisms, through which TCM impacts lung cancer, including the induction of cell death, reversal of drug resistance, inhibition of metastasis and modulation of immune responses. Additionally, future prospects for TCM in lung cancer treatment are discussed, offering insights into its expanded application and integration with modern medicine to address this challenging disease.

Keywords: Cancer immunology; Cancer metastasis; Chinese herbal medicine; Clinical trials; Combination therapy; Drug resistance; Lung cancer; Traditional Chinese medicine.

Fig. 1

Clinical evidence of TCM in lung cancer treatment. TCM has garnered substantial evidence from clinical studies, including extensive multicenter RCTs, meta-analyses and cohort studies. These studies underscore the effectiveness of TCM in (a) enhancing therapeutic outcomes when combined with platinum-based chemotherapy or EGFR-TKI therapy; (b) mitigating side effects induced by conventional treatments across various systems, including vascular, skin, immune system, liver and kidney, gastrointestinal and bone marrow; and (c) improving prognosis through TCM syndrome differentiation, addressing conditions such as Qi and blood deficiency, Yin and Yang dysregulation and fire syndrome

Fig. 2

The underlying mechanisms of TCM-induced cell death in lung cancer. A wide variety of TCMs, including both formulas and isolated bioactive components, can initiate diverse cell death mechanisms in lung cancer cells. These mechanisms include: apoptosis, autophagy, ferroptosis, pyroptosis, necroptosis, senescence and DNA damage. “↑” indicates activation, stimulation or promotion, whereas “⊥” indicates inhibition, suppression or decrease. Formula abbreviation: FJHQ-Fang ji huang qi decoction, HDI-Hedyotis diffusa injection

Fig. 3

TCM reverses resistance to conventional cancer therapies in lung cancer. Standard therapies for lung cancer include radiotherapy; platinum-based chemotherapy, such as cisplatin; and EGFR-TKIs targeted therapies, such as gefitinib, erlotinib and osimertinib. However, resistance to these treatments often develops through various mechanisms, including drug efflux, autophagy, glycolysis and signalling pathways such as the EGFR, Nrf2, HIF-1α and AKT pathways. TCM has shown the potential to overcome these resistance mechanisms, thereby enhancing the efficacy of conventional lung cancer therapies and achieving synergistic anti-cancer effects. “↑” indicates activation, stimulation or promotion, whereas “⊥” indicates inhibition, suppression or decrease. Formula abbreviation: YPF-Yu ping feng formula, DBD-Dang gui bu xue decoction, FYN-Fei yan ning, SMI-Sheng mai injection, BZYQD-Bu zhong yi qi decoction, JGD-Jie geng decoction

Fig. 4

TCM inhibits lung cancer metastasis. TCM provides a complementary approach to potentially suppress lung cancer metastasis through several key processes: a targeting CTCs and overcoming anoikis resistance; b reversing EMT; and (c) preventing the formation of pre-metastatic niche, disturbing ECM remodelling and inhibiting angiogenesis. “↑” indicates activation, stimulation or promotion, whereas “⊥” indicates inhibition, suppression or decrease

Fig. 5

TCM modulates immunology in lung cancer treatment. Combining TCM with immunotherapy could improve patient outcomes by addressing tumour-induced immune evasion and maintaining immune system balance. Key mechanisms include: a regulating immune cells; b enhancing the efficacy of immune checkpoint inhibitors, such as PD-1/PD-L1 inhibitors and IDO inhibitors; and (c) strengthening immune function to mitigate the adverse effects of standard cancer therapies. “↑” indicates activation, stimulation or promotion, whereas “⊥” indicates inhibition, suppression or decrease