Silymarin (Milk Thistle) for Hepatoprotection During Chemotherapy: A Systematic Review

Abstract

Introduction: Chemotherapy-induced liver injury is a significant clinical problem that can lead to treatment delays or discontinuation. Silymarin, the active extract from milk thistle, is widely used for its purported hepatoprotective effects. This review assesses its efficacy in preventing or treating chemotherapy-induced hepatotoxicity.

Methods: We conducted a systematic search for RCTs that evaluated the use of silymarin in cancer patients receiving potentially hepatotoxic chemotherapy. The primary outcome was the incidence and severity of liver enzyme elevations (ALT/AST).

Results: Eight RCTs, primarily in pediatric and adult leukemia patients, were included. The results consistently showed that patients receiving silymarin had significantly lower elevations in ALT and AST levels compared to placebo. This hepatoprotection often allowed for the completion of the prescribed chemotherapy regimen without dose reduction.

Discussion: Silymarin appears to be an effective agent for mitigating chemotherapy-induced hepatotoxicity. Its antioxidant and membrane-stabilizing properties likely contribute to this effect. It does not appear to interfere with the efficacy of chemotherapy.

Conclusion: Silymarin is a useful and safe intervention for protecting the liver during cancer chemotherapy.