Kvetching

The thrush and painfully tingly hands were so much worse today that I called both the oncologist and the naturopath to see what they could recommend.

Dr G said that the fluconazine should have worked immediately to relieve the thrush and sore throat, so he wonders if this is indeed a fungal infection. He recommends stopping the fluconazine and trying the Mycelex lozenges again. He also says the literature recommends DMSO 99% solution, applied topically to the hands. BUT it is absorbed into the body and gives one a fishy breath odor, so I think I will wait and see how I fare on Dr. B's recommendations.

Dr B the naturopath recommended increasing the L-glutamine powder to two teaspoons, taken three times a day, dissolved in water to treat the hand-foot syndrome. He also wants me to dissolve Pau d'Arco drops in a half-glass of water and rinse, also three times a day for the thrush. Dr G says the Pau d'Arco can't hurt.

I'd never heard about Pau d'Arco, but this is what Memorial Sloan Kettering Cancer Center says about it. I hope it does the trick!


Scientific Name
Tabebuia impetiginosa, Tabebuia avellanedae, Tabebuia heptaphylla

Common Name
Ipe-Roxo, lapacho, purple lapacho, trumpet bush and taheebo

Clinical Summary

Pau D'arco is a tree native to South America. Preparations derived from the bark have been traditionally used to treat bacterial, fungal, viral infections, and cancer. In vitro studies of compounds isolated from Pau D'arco demonstrated antibacterial (3) (4) (5) (6), antifungal (7), antipsoriatic (8), immunomodulatory (9) (10), anticancer (11) (12) (13) (14), and antimetastatic (14) activities. Quinones, the main constituents, have been shown to be the active principle (11) (12) (13) (14). In a small single-arm study, Lapachol, a naphthoquinone isolated from the tree bark, did not show any effects on patients with non-leukemic tumors or CML (chronic myelocytic leukemia) (15). Reported adverse events from use of Pau D'arco include nausea, vomiting, dizziness and anemia (16). This herb may also enhance the activity of anticoagulants (17).

Purported uses

Cancer treatment
Antibacterial
Antifungal

Constituents

Quinone compounds: Lapachol, beta-lapachone, xyloidone (naphthoquinones) and tabebuin (anthroquinone)
Flavonoids: Quercetin
Glycosides: Iridoid, lignan, isocoumarin, phenylthanoid, phenolic
Cyclopentene dialdehydes
(1) (2) (3)

Mechanism of Action

The anticancer activity of beta-lapachone, a quinone compound isolated from Pau D'arco, may be due to down regulation of COX-2 (cyclooxygenase) and telomerase activities (11). Beta-lapachone also induces apoptosis in cancer cells via mitochondrial-signaling (12) or by activation of caspase (3) and (9) enzymes (18). The anti-metastatic activity of beta-lapachone was shown to be due to decreasing the invasive ability of cancer cells by inducing Egr-1 that is known to suppress metatstasis (14).

Warnings

Some constituents may have toxic effects. The effectiveness of Pau d'arco for the treatment of cancer in humans remains unproven.

Adverse Reactions

Reported: Nausea, vomiting, dizziness, anemia, bleeding, and discoloration of urine (16).

Herb-Drug Interactions

Anticoagulants: Pau d'arco may potentiate effects (17).

Literature Summary and Critique

Block JB, et al. Early clinical studies with lapachol. Cancer Chemother Rep 1974;4:27-8.
Twenty-one patients with non-leukemic tumors or chronic myelocytic leukemia were given Lapachol at a dose range of 250-3750 mg daily for 5 days and up to 3000 mg daily for 21 days. Researchers reported that Lapachol did not have any effect on the clinical status of the patients.

References

1. Warashina T, Nagatani Y, Noro T. Further constituents from the bark of Tabebuia impetiginosa. Phytochemistry. 2005;66(5):589-597.
2. Koyama J, Morita I, Tagahara K, Hirai K. Cyclopentene dialdehydes from Tabebuia impetiginosa. Phytochemistry. 2000;53(8):869-872.
3. Park BS, Lee HK, Lee SE, et al. Antibacterial activity of Tabebuia impetiginosa Martius ex DC (Taheebo) against Helicobacter pylori. J Ethnopharmacol. 2006;105(1-2):255-262.
4. Anesini C, Perez C. Screening of plants used in Argentine folk medicine for antimicrobial activity. J Ethnopharmacol. 1993;39(2):119-128.
5. Park BS, Kim JR, Lee SE, et al. Selective growth-inhibiting effects of compounds identified in Tabebuia impetiginosa inner bark on human intestinal bacteria.J Agric Food Chem. 2005;53(4):1152-1157.
6. Pereira EM, Machado Tde B, Leal IC, et al. Tabebuia avellanedae naphthoquinones: activity against methicillin-resistant staphylococcal strains, cytotoxic activity and in vivo dermal irritability analysis. Ann Clin Microbiol Antimicrob. 2006;5:5.
7. Portillo A, Vila R, Freixa B, et al. Antifungal activity of Paraguayan plants used in traditional medicine. J Ethnopharmacol. 2001;76(1):93-98.
8. Muller K, Sellmer A, Wiegrebe W. Potential antipsoriatic agents: lapacho compounds as potent inhibitors of HaCaT cell growth. J Nat Prod. 1999;62(8):1134-1136.
9. Bohler T, Nolting J, Gurragchaa P, et al. Tabebuia avellanedae extracts inhibit IL-2-independent T-lymphocyte activation and proliferation.Transpl Immunol. 2008;18(4):319-323.
10. Son DJ, Lim Y, Park YH, et al. Inhibitory effects of Tabebuia impetiginosa inner bark extract on platelet aggregation and vascular smooth muscle cell proliferation through suppressions of arachidonic acid liberation and ERK1/2 MAPK activation. J Ethnopharmacol. 2006;108(1):148-151.
11. Lee JH, Cheong J, Park YM, Choi YH. Down-regulation of cyclooxygenase-2 and telomerase activity by beta-lapachone in human prostate carcinoma cells. Pharmacol Res. 2005;51(6):553-560.
12. Lee JI, Choi DY, Chung HS, et al. beta-lapachone induces growth inhibition and apoptosis in bladder cancer cells by modulation of Bcl-2 family and activation of caspases. Exp Oncol. 2006;28(1):30-35.
13. Kung HN, Chien CL, Chau GY, et al. Involvement of NO/cGMP signaling in the apoptotic and anti-angiogenic effects of beta-lapachone on endothelial cells in vitro. J Cell Physiol. 2007;211(2):522-532.
14. Kim SO, Kwon JI, Jeong YK, et al. Induction of Egr-1 is associated with anti-metastatic and anti-invasive ability of beta-lapachone in human hepatocarcinoma cells. Biosci Biotechnol Biochem. 2007;71(9):2169-2176.
15. Block JB, Serpick AA, Miller W, Wiernik PH. Early clinical studies with lapachol (NSC-11905). Cancer Chemother Rep 2. 1974;4(4):27-28.
16. Foster S. Tyler's Honest Herbal: A Sensible Guide to the Use of Herbs and Related Remedies. New York: Haworth Herbal Press; 1999.
17. Brinker F. Herb Contraindications and Drug Interactions. 2nd ed. Sandy (OR): Eclectic Med Publications; 1998.
18. Woo HJ, Park KY, Rhu CH, et al. Beta-lapachone, a quinone isolated from Tabebuia avellanedae, induces apoptosis in HepG2 hepatoma cell line through induction of Bax and activation of caspase. J Med Food. 2006;9(2):161-168.