Preclinical anticancer activity of Typhonium flagelliforme (Lodd.) Blume and its potential mechanism: A systematic review

Abstract

Objective

To assess the potential of Typhonium flagelliforme (Lodd.) Blume (T. flagelliforme, Bian Yan Li Tou Jian), a traditional Chinese medicinal plant, as an anticancer agent in a systematic review of preclinical research.

Methods

Seven databases, namely, Scopus, PubMed, Web of Science, ScienceDirect, LILACS, EBSCO Medline, and Mendeley were thoroughly searched from their inception up until September 8, 2023. Peer-reviewed English language studies that conducted in vitro and in vivo investigations of T. flagelliforme extracts, fractions, or isolated compounds were included. Clinical trials and non-original peer-reviewed reports were excluded. The effectiveness of T. flagelliforme on various cancer cells, tumor sizes, and mechanisms was qualitatively assessed. The quality of evidence was assessed using the ToxRTool by three independent raters, and their consistency was verified.

Results

The search included 27 studies: 22 in vitro, four in vivo, and one involving both. T. flagelliforme extracts were shown to be effective against leukemic, breast, colorectal, and lung cancers. Most studies had “Reliable with Restrictions” scores. T. flagelliforme induced apoptosis by halting the cell cycle, activating caspase-3/-9, cleaving PARP, fragmenting DNA, reducing survivin, decreasing ROS, suppressing COX-2 and HSP70, and inhibiting the NF-κB pathway. When combined with interferon, T. flagelliforme exerts antiangiogenic effects.

Conclusion

Although T. flagelliforme shows promising activity against cancer, its efficacy as a standalone anticancer treatment remains uncertain. It appears to be better suited as complementary or combined therapy. The lack of conclusive evidence could be attributed to suboptimal study design, incomplete reporting, and inadequate inclusion of proper positive controls and statistical analyses across multiple articles.