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eicosapentaenoic acid, docosapentaenoic acid, Traditional Chinese medicines
and docosahexaenoic acid, protected against the It has been suggested that use of Chinese herbal
development of HCC, irrespective of HCV or HBV medicines might result in the protection of liver
status. The effect of treatment with high dose function during chemotherapy. [109] The herbal
[97]
purified long chain omega-3 fatty acids on liver fat formulation PHY906 consists of four commonly used
percentage and scores for liver fibrosis in patients herbs, i.e. Scutellaria baicalensis Georgi, Paeonia
with NAFLD is currently being investigated in a lactiflora Pall, Glycyrrhiza uralensis Fisch, and
randomized double blind placebo controlled trial. [98] Ziziphus jujube Mill, at a ratio of 3:2:2:2. Studies have
shown that PHY906 not only reduces gastrointestinal
Spirulina platensis toxicity and enhances the antitumor efficacy of some
Spirulina is a blue-green alga (cyanobacterium) anticancer drugs but also alleviates chemotherapy-
available as a dietary supplement. In vitro studies have induced side effects, such as diarrhea. [109] Preliminary
demonstrated that spirulina may exert hepatoprotective clinical data indicate that PHY906 can serve as
effects. In patients with chronic hepatitis C infection, an adjuvant to chemotherapy in the treatment
[99]
viral load and ALT levels tended to improve after 6 months of advanced HCC. [110] Other traditional Chinese
of treatment with spirulina in a small, active-controlled medicines that may have a role in the treatment of
trial. [100] Another small, uncontrolled trial reported HCC are bufotoxin (toad skin secretion), astragalus
significant improvements in aspartate aminotransferase, and products containing ginseng (Panax ginseng),
alanin aminotransferase, gamma-glutamyltransferase, astragalus and mylabris (dried body of the Chinese
triglycerides, low-density lipoprotein-cholesterol, blister beetle). [111]
total cholesterol, and the ratio of total cholesterol to
high-density lipoprotein cholesterol after 6 months CONCLUSION
of treatment in patients with NAFLD. According to
the authors, spirulina supplementation resulted Identifying modifiable risk factors such as diet is
also in a significant reduction in weight and insulin important to counteract HCC. Dietary patterns are
resistance, and a significant improvement in health- complex to assess, and are entangled with other
related quality of life was observed. However, no aspects of lifestyle. To date, conclusive evidence
changes in sonographic findings were observed. [101] supporting a detrimental or beneficial role in the
prevention of chronic liver diseases is available only
Antioxidants for few products. Available information on coffee,
Reduced glutathione (GSH) is a potent antioxidant fish and BCAAs supplementation is of acceptable
naturally occurring in the body, and is available for quality and supports a beneficial role for these
parenteral administration. Very few studies have products in the prevention and management of HCC.
assessed the therapeutic role of GSH in liver diseases. On the other hand, the detrimental effects of alcohol
In an Italian study that compared the effects of reduced and aflatoxins are widely recognized. Excessive sugar
GSH and vitamin K in patients with alcoholic liver and calorie consumption should also be avoided.
disease, those treated with reduced GSH showed a
greater improvement of hepatic function vs. patients Financial support and sponsorship
treated with vitamin K. [102] A study published several Nil.
years ago assessed the effect of GSH treatment on HCC
in 8 patients with biopsy-proven HCC not amenable Conflicts of interest
to surgery, but results were inconclusive. [103] Besides There are no conflicts of interest.
direct GSH supplementation, hepatic GSH deposits REFERENCES
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Both compounds are generally very well tolerated, P, Musso A, De Paolis P, Capussotti L, Salizzoni M, Rizzetto M.
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function in chronic liver diseases. [104-106] cryptogenic cirrhosis to hepatocellular carcinoma. Gastroenterology
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2. Falck-Ytter Y, Younossi ZM, Marchesini G, McCullough AJ. Clinical
Finally, it has been observed that patients with HCC features and natural history of nonalcoholic steatosis syndromes.
have low levels of serum vitamin B [107] and vitamin Semin Liver Dis 2001;21:17-26.
D, [108] which suggests that these patients might 3. Sacco R, Sivozhelezov V, Pellegrini L, Giacomelli L, Longo V.
Dietary supplementation in cancer patients: a personal view of
benefit from supplementation with these vitamins. current status and future perspectives. Future Oncol 2014;10:1523-5.

58 Hepatoma Research | Volume 2 | March 9, 2016