[Cancer] Adding herbal medicine to TACE for liver cancer raises response and survival while lowering side effects

"Is it okay to take herbal medicine while I'm receiving embolization?" This is one of the questions patients facing or undergoing liver cancer (hepatocellular carcinoma, HCC) treatment ask most often. Recent evidence points in a clear direction: adding herbal medicine to standard embolization tends to raise treatment response and survival while lowering the side effects that follow the procedure. Let us look at the actual evidence.

Pooling 39 randomized controlled trials in a Bayesian network

Published in 2024 in the journal Frontiers in Pharmacology, this study is a meta-analysis that gathered only randomized controlled trials (RCTs) of transarterial chemoembolization (TACE) — a mainstay treatment for liver cancer — combined with herbal medicine. It pooled 39 trials comparing TACE alone with TACE plus herbal medicine, and went further with a Bayesian network meta-analysis to rank which formulas fared better, and a network pharmacology analysis to trace, at the gene and protein level, why the herbs work. In other words, it captured the size, the ranking, and the reason for the effect in a single paper.

Across studies on gastric, liver, colorectal, lung, breast and pancreatic cancer, the pattern that keeps recurring is that individual studies — from different countries, cancers and research teams — reach strikingly consistent conclusions: herbal medicine helps delay cancer onset (prevention), lowers mortality, raises survival and quality of life, and reduces the side effects that accompany standard treatment. This liver-cancer embolization study traces the same trajectory.

Raising both tumor response and survival

First, efficacy. Compared with TACE alone, the combination group had a roughly twofold higher objective response rate (ORR) — the proportion whose tumors actually shrank (odds ratio OR 2.00, 95% confidence interval 1.65–2.43, P<0.00001). The disease control rate (DCR), the proportion whose tumors did not progress, was about 1.85 times higher (OR 1.85, 1.50–2.29). Above all, survival. Overall survival (OS) favored the combination group at every time point observed, and the gap widened over time — from about 2.0 up to 2.8 times higher (OR 2.01·2.43·2.45·2.77, each with a lower confidence limit above 1 and P<0.00001).

Every figure points the same way. Receiving the same embolization, patients who also took herbal medicine had tumors that shrank more often and lived longer — and that benefit grew with time.

Curbing the side effects that follow embolization

In fact, the more striking part of this study is the side effects. Embolization is a powerful treatment that blocks the vessels feeding a tumor to concentrate chemotherapy there, but it brings the so-called post-embolization syndrome — abdominal pain, fever, nausea and vomiting — along with reduced liver function. Adding herbal medicine significantly reduced most of these burdens. The risk of abdominal pain fell markedly (OR 0.34), as did nausea (OR 0.26), gastrointestinal reactions (OR 0.11), liver injury (OR 0.30) and fever (OR 0.56), and blood-related effects such as leukopenia and thrombocytopenia also declined (all odds ratios below 1). Some items, such as diarrhea and myelosuppression, showed no clear difference, so it does not block every side effect equally.

Curbing side effects so that a patient can complete the planned embolization schedule — this is the most important effect of all, easy to overlook yet the one that translates into survival.

Which formulas came out ahead — the power of supporting vital energy

The researchers used the Bayesian network to rank the formulas. They grouped the herbs by character into three approaches — Shugan (soothing the liver's energy), Huayu (resolving blood stasis) and Fuzheng (supporting vital energy) — and the approach that raised the response rate most was Fuzheng, which bolsters the body's vital energy. At its peak stood the Ganfu Formula (Ganfu Formula; ranking probability 89.19%). In the Huayu group the Anti-cancer Formula led (83.16%), and in the Shugan group Xiao Chaihu Decoction led (73.59%). That said, the response benefit of the Ganfu Formula over TACE alone had a very wide confidence interval (OR 11.75, 1.58–92.91), so it should be interpreted with caution.

The ten most frequently used herbs were also identified: Baizhu (Atractylodes macrocephala), Huangqi (Astragalus membranaceus), Fuling (Poria cocos), Dangshen (Codonopsis pilosula), Gancao (Glycyrrhiza uralensis), Ezhu (Curcuma zedoaria), Chaihu (Bupleurum chinense), Baihuasheshecao (Hedyotis diffusa), Baishao (Paeonia lactiflora) and Chenpi (Citrus reticulata). What stands out is that the center of gravity of these formulas is not to attack the tumor directly. Rather than targeting the cancer itself, Korean medicine focuses on restoring the environment — digestion, stamina and immunity — that standard treatment tends to erode. Just as good soil lets crops thrive, a patient whose stamina holds up can complete embolization as scheduled, and that completion connects to response and survival.

Why herbal medicine works — a look through network pharmacology

The study went one step further, tracing at the gene level why the herbs work. Crossing the herbs' active compounds with liver-cancer-related targets, it narrowed the field to 17 core genes and, analyzing the pathways they act on, found clues to anti-tumor activity especially in proteoglycan pathways — involved in tumor proliferation, metastasis and the tumor microenvironment — and in lipid metabolism. The "why" behind formulas long used empirically is gradually being filled in at the molecular level.

In closing

This study, too, reaches the same conclusion as the liver-cancer columns introduced earlier: adding herbal medicine to a standard treatment such as embolization can raise response and survival while lowering side effects.

It should be read with balance, however. Most of the included trials were conducted in China, a signal of publication bias was detected for the objective response rate, and some formulas had very wide confidence intervals. These results are therefore best read as evidence of possibility and association.

If you are receiving or about to receive embolization for liver cancer, we encourage you to discuss combining herbal medicine with an integrative-oncology Korean medicine doctor.