TY  - EJOU
AU  - Chang, Tsung-Kun 
AU  - Yin, Tzu-Chieh 
AU  - Su, Wei-Chih 
AU  - Tsai, Hsiang-Lin 
AU  - Huang, Ching-Wen 
AU  - Chen, Yen-g 
AU  - Li, Ching-Chun 
AU  - Chen, Po-Jung 
AU  - Ma, Cheng-Jen 
AU  - Chuang, Kuo-Hsiang 
AU  - Cheng, Tian-Lu 
AU  - Wang, Jaw-Yuan 

TI  - A Pilot Study of Silymarin as Supplementation to Reduce Toxicities  in Metastatic Colorectal Cancer Patients Treated With First-Line  FOLFIRI Plus Bevacizumab
T2  - Oncology Research

PY  - 2020
VL  - 28
IS  - 7-8
SN  - 1555-3906

AB  - Irinotecan, a topoisomerase inhibitor, is a common cytotoxic agent prescribed for metastatic colorectal cancer 
(mCRC) patients. Diarrhea is the most common adverse event (AE). The underlying mechanism of irinotecaninduced diarrhea is intestinal mucosal damage caused by SN-38 (active metabolite of irinotecan) hydrolyzed 
from SN-38G (inactive metabolite) by bacterial -glucuronidase ( G). According to an animal study, silymarin 
reduces the activity of bacterial G without impairing antitumor efficacy. We conducted a prospective openlabel pilot study to evaluate the effect of silymarin as supplementation in reducing toxicities of mCRC patients 
undergoing irinotecan-based chemotherapy. We enrolled and randomized 70 mCRC patients receiving first-line 
FOLFIRI (5-fluorouracil/leucovorin/irinotecan) plus bevacizumab. In each treatment cycle, the study group 
was administered silymarin capsules (150 mg) three times daily for 7 days. The study group experienced less 
AEs in diarrhea (5.7% vs. 14.6%, <i>p</i>=0.002) and nausea (27.0% vs. 40.2%, <i>p</i>= 0.005) in comparison with the 
control group, but no significant differences in hepatic toxicities were observed. In conclusion, simultaneous 
administration of silymarin is a potential effective supplementation for reducing toxicities in mCRC patients 
undergoing first-line FOLFIRI plus bevacizumab, especially in diarrhea and nausea.
KW  - Silymarin; FOLFIRI plus bevacizumab; Metastatic colorectal cancer; Toxicity

DO  - 10.3727/096504021X16218531628569