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A Chinese herbal product, called sho-saiko-to, may be of use in delaying or preventing the onset of liver cancer in some persons who have cirrhosis of the liver, according to a recent report by Japanese researchers.

Primary cancer of the liver is characterized by cancer cells that begin to grow in the liver, the largest organ in the human body. These cancer cells can then grow in size and can also spread to the veins or arteries of the liver and/or to other parts of the body (called advanced or metastatic disease). The most common type of primary liver cancer is called hepatocellular carcinoma. The treatment of hepatocellular carcinoma depends on many factors including the size and stage of the cancer (extent of disease at diagnosis) and the overall health of the patient. When the cancer is detected early, it is sometimes possible for it to be completely removed from the liver by surgery (called surgical resection), offering a chance for cure. For this reason, an awareness of the risk factors for the development of hepatocellular carcinoma is especially important.

When individuals are at an increased risk for developing a type of cancer, this means that they have certain characteristics or exposures, called risk factors, that make them more likely to develop that type of cancer than those who do not have these risk factors. Risk factors are determined by studying and comparing the characteristics of persons who do and do not have a type of cancer. An awareness of these risk factors is important because 1) some risk factors can be changed (such as smoking or diet), thus decreasing the risk for developing the associated cancer; and 2) persons who are at an increased risk for developing a cancer can often undergo screening (testing) measures for that cancer type and thus detect any cancer early.

Two risk factors that are known to be associated with the development of hepatocellular carcinoma include being infected with hepatitis B or C and having cirrhosis of the liver. In fact, 50 to 80% of persons who have hepatocellular carcinoma also have cirrhosis, and about 5% of all persons with cirrhosis go on to develop this type of cancer. This may be because of the relationship between the presence of scar tissue (fibrosis), which may occur with cirrhosis, and the development of liver cancer. Researchers continue to study ways to prevent liver cancer from developing in persons who have cirrhosis. This use of medicine to try to prevent or prolong the steps that lead to the development of cancer is commonly referred to as chemoprevention.

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Researchers in Japan recently conducted a study to determine whether a Chinese herbal product, called sho-saiko-to (or TJ-9), would be useful as a cancer chemoprevention agent in persons with cirrhosis of the liver. Sho-saiko-to consists of 7 different herbal preparations, a combination that has been shown in animal studies to have anti-fibrosis and anti-cancer activity. Two hundred sixty patients with cirrhosis were assigned to receive either A) sho-saiko-to plus the conventional drugs usually given; or B) only the conventional drugs usually given. The patients were then monitored for 60 months. The results showed that fewer persons taking the sho-saiko-to developed hepatocellular carcinoma compared with those taking only conventional medicines. After 5 years, 75% of patients receiving the sho-saiko-to were alive compared with 61% receiving only the conventional medicines. In addition, this discrepancy in survival was more pronounced in individuals who had both cirrhosis and hepatitis B.

These findings suggest that the use of sho-saiko-to may help prevent or slow down the development of hepatocellular cancer in persons with cirrhosis. It may be that this herbal product slows or prevents the progression of fibrosis, thus also preventing progression to cancer. Other antifibrosis therapies may also be appropriate for evaluation for any potential benefit in the prevention of liver cancer. (Cancer, Vol 76, No 5, pp 743-749, 1995)