Andrographis paniculata (Burm. f.) Nees (A. paniculata), commonly known as "King of Bitters," has been widely used in traditional medicine in Asia, primarily for its heat-clearing, detoxifying, anti-inflammatory hepatoprotective properties. Andrographolide (AG), a bioactive compound derived from A. paniculata has been extensively investigated for its anticancer potential. Numerous studies have demonstrated its efficacy across various cancers, highlighting the potential of AG as a promising drug for cancer therapy. This review aims to systematically summarize the ethnopharmacological uses of A. paniculata and its main compound AG, the anticancer mechanisms, preclinical toxicity analysis and clinical therapeutic potential of AG, focusing on its multi-targeted actions across various cancer types and its application in clinical trials. A comprehensive literature survey was conducted using English medium databases from 2015 to 2025. After applied the exclusion and inclusion criteria, 102 articles related to the keywords of “Andrographis paniculata”, “Andrographis paniculata traditional uses”, “andrographolide anticancer”, “andrographolide toxicity and safety”, “andrographolide adverse reactions” and “Andrographolide clinical trial” were compiled for critical review. AG exerts its anticancer effects in animal and different cancer cell lines via various mechanism inducing apoptosis, promoting autophagy, triggering ferroptosis, and arresting the cell cycle, etc. AG is relatively safe compound with less toxicity in vivo and in vitro. The clinical trials and findings for different disease have been investigated and summarized. Andrographolide has the potential to be a promising drug for cancer treatment. The combination with other drugs and natural compounds can improve therapy. The toxicity and clinical trials need further study.
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