Comparison of the Complications of Platinum-Based Adjuvant Chemotherapy With and Without Ginger in a Pilot Study on Ovarian Cancer Patients

Of all the female malignancies, most clinical discussions focus on ovarian cancer. It has the highest case fatality ratio and it is the fifth most common cause of malignancyrelated death among women. The cancer is associated with low parity and infertility. Early menarche and late menopause increase the risk of ovarian cancer. Ovarian cancers include epithelial and non-epithelial tumors. More than 80% of epithelial ovarian cancers are seen in postmenopausal women. The peak incidence of epithelial ovarian cancer is between 55 to 60 years of age. Data show that feature of CA125 increases if the test is performed by transvaginal ultrasound. Its symptoms include complex pelvic mass such as solid pattern, heterogeneous component with irregular thick septum, bilateral masses, and size of lesions exceeding 8 cm. The effective factors in the prognosis of ovarian cancer are divided into the 3 categories of pathological, biological and clinical factors. The pathological factors include the structure and degree of lesion. The biological factors include ploidy and proto-oncogenes such as HER-2neu. The clinical factors include the stage of tumor, the extent of residual disease after primary surgery, volume of ascites, age of the patient, and functional status of patient. Ovarian cancer treatment includes primary cytoreductive and then chemotherapy (1). Chemotherapy may be associated with the complications such as nausea and vomiting, bone marrow depression, peripheral neuropathy, weight loss, hemolytic anemia, and transient cortical blindness (2). Ginger is a plant with anti-carcinogenic and antioxidative effects and modern studies have shown other treatment effects such as the ability to inhibit formation of inflammatory products, direct antiinflammatory effects, and anti-tumoral effects. It has been proved that the active ingredient in ginger can kill cancer cells due to apoptosis and autophagocytosis. This has also been emphasized in ovarian cancers (2). On the other hand, although chemotherapy drugs suppress inflammatory markers, cancer cells may show resistance to them. It has been proved that ginger can Abstract Objectives: The principal treatment of ovarian cancer is surgery with or without chemotherapy. The chemotherapy, however, might be ineffective and long with serious side-effects. To obviate these shortcomings, more efficient and safer medications are required, among which ginger has recently gained popularity because of its anti-cancer properties. This study aims to compare outcomes and side-effects of adjuvant chemotherapy with and without ginger in ovarian cancer patients. Materials and Methods: A total of 49 patients (20 patients in case group and 29 patients in control group) with stage I to III, histopathologically proved ovarian cancer underwent cytoreductive surgery followed by platinum-based adjuvant chemotherapy with and without investigator-prepared oral ginger capsules (2 g per day for 6 cycles). Potential side-effects, poor 12-month outcome (serum CA125 levels >35U, radiologic evidence of metastasis and recurrence, or death), and 12-month disease-free survival were documented and compared between the 2 groups. Results: Poor outcome including serum CA125>35, metastasis, recurrence or death was documented more common in control group (69% versus 40%). metastasis frequency confirmed by computerized tomography (CT) scan 6 month after treatment was significantly lower in case group (P = 0.04). There was no significant difference regarding mortality and disease free survival during one year follow-up after treatment between 2 groups (P = 0.55). Chemotherapy complications such as nausea, vomiting, weight loss, and peripheral neuropathy were detected in case group less than control group but the difference was not significant. Conclusion: Oral administration of ginger is along with a significantly better 12-month outcome in patients on chemotherapy because of ovarian cancer, and accordingly, considering its safety, its administration is recommended.