Graviola (Annona muricata)

Integrative Oncology is the synthesis of mainstream care and nonpharmacologic, evidence-based complementary therapies for the control of cancer-related physical and emotional symptoms. Herb-drug interactions and other cautions are also encompassed. In this first installment of ONCOLOGY’s new department, we review “graviola.” Graviola was chosen for review because it is one of the most commonly searched terms sought by visitors to MSKCC’s “About Herbs” website. Because graviola is commonly promoted as a cancer treatment, your patients may be inclined to take it.

Herbal supplements are commonly used by cancer patients for symptom relief and also in efforts to treat the disease itself. Patients should understand that herbal supplements are not viable substitutes for mainstream cancer care. Moreover, there is substantial potential for herb-drug interactions that may reduce the efficacy of chemotherapeutic agents.

Despite the absence of supportive data, graviola, like many herbal products, is heavily promoted to cancer patients on the Internet, often with false claims of cure. Patients should be cautioned against herbal supplement use when on treatment.

Because reliable information about herbs and other dietary supplements was not readily available to oncologists who need it to counsel their patients, the MSKCC Integrative Medicine Service developed and maintains a free website. The “AboutHerbs” website (http://www.mskcc.org/AboutHerbs) now has two portals, one for oncology professionals and another for the public. Anyone may enter either portal at no cost. This site is updated continually and provides objective information on herbs and other botanicals as well as vitamins, other dietary supplements, and unproved cancer therapies. Visit the MSKCC website and watch for coverage of other common herbal products and complementary therapies in future issues of ONCOLOGY.

-Barrie Cassileth, PhD

SCIENTIFIC NAME: Annona muricata

ALSO KNOWN AS: Cherimoya, guanabana, corossol, soursop, custard apple, brazilian paw paw

USES: Graviola is used as a sedative and to treat infections, herpes, and cancer.

BACKGROUND: Graviola is an evergreen tree native to Mexico, the Carribean, and Central and South America. It is also grown in parts of Southeast Asia. The fruits, seeds, and leaves are used to treat stomach ailments, fever, parasitic infections, hypertension, and rheumatism. It is sold as capsules, tablets, powder for infusions (very dense teas), and tinctures.

RESEARCH: Acetogenins, phytochemicals isolated from the leaves, bark, and twigs of graviola, are thought to be the active ingredients. Ethanolic extracts of graviola were effective against Herpes simplex virus,[1] leishmania, a protozoan that causes leishmaniasis,[2] and the freshwater mollusk Biomphalaria glabrata, which acts as a host for the parasitic worm Schistosoma mansoni.[3]

Alkaloids extracted from graviola were found detrimental to the survival of dopaminergic nerve cells in vitro[4] and can cause neuronal dysfunction and degeneration. Graviola may also have antidepressive activity due to its ability to stimulate serotonin receptors.[5]

Extracts of graviola demonstrated cytotoxic effects against hepatoma cells[6] and doxorubicin-resistant human mammary adenocarcinoma cells[7] by blocking ATP utilization and by inhibiting activity of plasma membrane glycoprotein. But human studies are lacking.

ADVERSE EFFECTS: Graviola may cause movement disorders and myeloneuropathy with symptoms similar to Parkinson’s disease.[5]

SUMMARY: Graviola demonstrated anticancer effects in vitro, but has not been studied in humans. Despite the lack of human data, many websites promote graviola to cancer patients based on traditional use and on the in vitro studies. Caution is required as there is no evidence of safety or efficacy.

References:

REFERENCES
1. Padma P et al: J Ethnopharmacol 61:81-83, 1998.
2. Jaramillo MC et al: Fitoterapia 71:183-186, 2000.
3. dos Santos AF, Sant’Ana AE: Phytomedicine 8:115-120, 2001.
4. Lannuzel A et al: Mov Disord 17:84-90, 2002.
5. Roman G: Curr Opin Neurol 11:539-544, 1998.
6. Chen JC et al: Am J Chin Med 28:175, 2000.
7. Oberlies NH, Chang CJ: J Med Chem 40:2102-2106, 1997.
For additional information, visit

www.mskcc.org/AboutHerbs

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