Medicinal Plants for Chemotherapy-Induced Nausea and Vomiting: A Systematic Review of Antiemetic, Chemosensitizing, and Immunomodulatory Mechanisms

Abstract

Background: Chemotherapy-induced nausea and vomiting (CINV) is a major burden for cancer patients, often poorly managed by conventional antiemetics, prompting exploration of medicinal plant therapies for better supportive care.

Objective: This systematic review critically evaluates medicinal plants for CINV, detailing bioactive compounds, diverse antiemetic mechanisms, and promising chemosensitizing and immunomodulatory properties.

Methods: A comprehensive literature search and critical analysis of studies investigating medicinal plants for CINV were performed.

Key findings: This review synthesizes evidence for 22 botanicals. Ginger (gingerols, shogaols) acts via 5-hydroxytryptamine 3 (5-HT₃) receptor antagonism and substance P/neurokinin-1 (NK-1) inhibition, and offers chemosensitization by downregulating P-glycoprotein. Cannabis (THC, CBD) modulates the endocannabinoid system and 5-HT₃ receptors for CINV relief and may enhance chemotherapy sensitivity. Mint (menthol, menthone) relaxes gastrointestinal smooth muscle and offers anti-inflammatory benefits. Chamomile (apigenin) has antispasmodic/anxiolytic effects; its apigenin also sensitizes cancer cells to chemotherapy. Turmeric (curcumin) acts on neurotransmitter systems, offers potent anti-inflammatory/antioxidant effects, and boosts chemosensitivity via NF-κB/P-gp modulation. Plants like Pinellia ternata, lemon, fennel, and licorice show varied mechanisms (gastrointestinal regulation, anti-inflammatory, neurotransmitter modulation). Many botanicals show chemosensitizing (inhibiting efflux pumps, promoting apoptosis) and immunomodulatory (affecting cytokines, immune cells) properties. Synergistic plant combinations (eg, ginger with P. ternata or turmeric) are noted for enhanced efficacy and safety.

Conclusion: Medicinal plants offer a compelling, multi-targeted approach for CINV management, with potential beyond symptomatic relief via their antiemetic, chemosensitizing, and immunomodulatory actions. Rigorous clinical trials are needed to integrate these botanicals into evidence-based supportive cancer care.

Keywords: cancer; chemotherapy; complementary medicine; herbal medicine; nausea; vomiting.

Figure 1

Key Peripheral and Central Neurochemical Pathways in Chemotherapy-induced nausea and vomiting (CINV) Targeted by Standard Antiemetic Therapies. This diagram illustrates the primary mechanisms of CINV targeted by conventional antiemetics. Emetogenic signals are initiated via two main routes. Peripheral Pathway: Chemotherapy or tumor factors damage gastrointestinal enterochromaffin cells, releasing serotonin. 5-hydroxytryptamine (5-HT) activates 5-hydroxytryptamine type 3 receptor (5-HT3) on vagal afferents, transmitting emetic signals to the central nervous system. Central Pathway: Signals from the vagus nerve and direct effects of chemotherapy converge on the Chemoreceptor Trigger Zone (CTZ) in the brainstem. Here, substance P activates Neurokinin-1 (NK-1) receptors, further propagating emetic signals. Both pathways relay information to the vomiting center, which coordinates abdominal muscle contractions and altered gastrointestinal peristalsis, leading to nausea and vomiting.

Figure 2

Comparative Overview of Antiemetic Mechanisms: Standard Pharmacological Agents Versus Selected Medicinal Plants and Their Bioactive Components in the Management of Chemotherapy-induced nausea and vomiting (CINV). This figure contrasts mechanistic targets of conventional antiemetics (left) with diverse pathways of medicinal plants (right) in CINV. Standard antiemetics target specific receptors; medicinal plants often use multiple synergistic mechanisms (receptor modulation, anti-inflammatory, GI regulation). Left Panel: Conventional CINV drugs target specific neurochemical pathways. Neurokinin-1 Receptor Antagonist (NK-1RA): aprepitant. Corticosteroids: dexamethasone. 5-hydroxytryptamine type 3 receptors antagonist(5-HT3RA): ondansetron (See Figure 1 for standard CINV pathway details). Right Panel: Medicinal plants offer multi-targeted CINV approaches, grouped by predominant mechanisms. Cannabidiol (CBD) system regulation: CBD. Dopamine (DA) Receptor Inhibition: Zingiber officinale (Z.O.). NK-1RA: Z.O. and Curcumin (CUR). Olfactory Pathway Regulation (Aromatherapy): Citrus limon (C.L.) and Mentha spicata (M.S.). Plant-Based 5-HT3 Receptor Antagonism: Z.O., CBD, C.L., CUR, Glycyrrhiza glabra (G.G.), Pinellia ternata (PPT), Evodia rutaecarpa (E.R.) and Panax ginseng (P.G.). Anti-inflammatory Effects: All (Refers to all medicinal plants mentioned in the article as contributing to this general mechanism). Gastrointestinal (GI) Activity Regulation: All.