Devita, Hellman, and Rosenberg's Cancer

LWBK1006-48 LWW-Govindan-Review December 12, 2011 20:53

Chapter 48•Complementary, Alternative, and Integrative Therapies in Cancer Care 591

Question 48.6. A 60-year-old Hispanic man with early-stage squamous cell carcinoma

of the lung has recently undergone surgical resection. He comes to your

office for recommendations on adjuvant chemotherapy. He tells you that

after his surgery he has been taking some herbal supplements “to fight his

cancer,” sent by his friend from Mexico. He has felt weak and anorec-

tic for the past few weeks and experienced mild intermittent pain in the

right upper quadrant of his abdomen. He takes no other medications,

including over-the-counter medications. He does not use alcohol regu-

larly and had no other known medical disorders. On examination of

the patient, jaundice was noted, but no other significant findings were

present. His initial laboratory test results revealed abnormal liver func-

tion tests, with total bilirubin 5.9 mg/dL, direct bilirubin 4.4 mg/dL,

aspartate aminotransferase 52 U/L, alanine aminotransferase 272 U/L,

total alkaline phosphatase 153 U/L, and-glutamyltransferase 226 U/L

(0 to 45 U/L). The prothrombin time was normal. Which of the following

herbal supplements has been associated with severe hepatotoxicity?

A. Mistletoe

B. Chaparral

C. Green Tea

D. Maitake

Question 48.7. Which of the following herbal remedies has been widely used for treat-

ment of prostate cancer?

A. Kava (Piper methysticum)

B. Ginger (Zingiber officinale)

C. PC-SPES

D. Alfalfa (Medicago sativa)

Question 48.8. A 48-year-old Caucasian man with diffuse large B-cell lymphoma is

receiving chemotherapy with R-CHOP. He bought a nutritional supple-

ment containing Coenzyme Q10 from a health food store. He asks you

if this would “improve tolerance for chemotherapy.” Which of the fol-

lowing responses is most accurate regarding the use of Coenzyme Q10

supplements in patients undergoing chemotherapy?

A. Coenzyme Q10 reduces the cardiotoxicity from anthracyclines when

administered for 3 weeks prior to start of therapy.

B. Coenzyme Q10 decreases chemotherapy-related fatigue.

C. There is slight increase in the hepatotoxicity when co-administered

with anthracyclines.

D. There is no evidence from randomized controlled trials that Coen-

zyme Q10 has cardioprotective effects.