Bojungikki-tang + gefitinib

The combination of Bojungikki-tang (BJIKT) and gefitinib represents a treatment approach that combines traditional herbal medicine with targeted cancer therapy. This combination has been studied particularly for non-small cell lung cancer (NSCLC) patients with EGFR mutations. ## Description Bojungikki-tang (also known as Bu Zhong Yi Qi Tang in China and Hochuekkito in Japan) is a traditional herbal medicine formula composed of multiple herbs including Ginseng Radix, Atractylodis Rhizoma Alba, Astragali Radix, Angelicae Gigantis Radix, Citri Unshius Pericarpium, Bupleuri Radix, Cimicifugae Rhizoma, and Glycyrrhizae Radix et Rhizoma[1][6]. It has been traditionally used for treating fatigue, appetite loss, and improving immune function[5][6]. Gefitinib is a first-line palliative chemotherapy drug used to treat advanced non-small-cell lung cancer (NSCLC) in patients with epidermal growth factor receptor (EGFR) mutations. It works as an EGFR-tyrosine kinase inhibitor[1][3]. When combined, modified Bojungikki-tang appears to enhance the anti-cancer effect of gefitinib in NSCLC patients with EGFR mutations. In a notable case study, despite reduction in gefitinib dosage due to severe skin rashes (a common side effect), the combination maintained progression-free survival for approximately 78 months in an advanced NSCLC patient[1][2][3]. This suggests that BJIKT may enhance gefitinib's efficacy and potentially delay acquired resistance, which is a major limitation of gefitinib monotherapy[1][3]. ## Mechanism of Action Gefitinib works by inhibiting EGFR tyrosine kinase, blocking signal transduction pathways implicated in cancer cell proliferation and survival. Bojungikki-tang appears to have immunomodulatory effects that may complement gefitinib's action. Studies indicate that BJIKT has multiple mechanisms including: - Immunomodulatory effects that enhance T-cell responses[5][7] - Regulation of immune suppression and activation[7] - Influence on the tumor microenvironment[7] - Potential to delay acquired resistance to gefitinib[1][3] ## Development Status The combination has been studied in case reports showing promising results for advanced NSCLC with EGFR mutations[1][2][3]. A clinical trial is currently evaluating BJIKT in combination with pembrolizumab (an anti-PD-1 antibody) for NSCLC, suggesting ongoing interest in combining this herbal formula with various cancer immunotherapies[7]. ## Composition of Bojungikki-tang The traditional formula typically contains: - Ginseng Radix (Panax ginseng) - Astragali Radix (Astragalus membranaceus) - Atractylodis Rhizoma Alba (Atractylodes macrocephala) - Glycyrrhizae Radix et Rhizoma (Glycyrrhiza uralensis) - Angelicae Gigantis Radix (Angelica gigas) - Citri Unshius Pericarpium (Citrus unshiu) - Cimicifugae Rhizoma (Cimicifuga heracleifolia) - Bupleuri Radix (Bupleurum falcatum)[6][8] The specific modified version used in the case study with gefitinib may have had adjustments to this traditional formula.