1. Introduction

Liver cancer is one of the most common malignancies with high morbidity and mortality all over the world. Despite the number of new cases of liver cancer appears to be plateauing, large population size of liver cancer patients, especially in China, still greatly contributes to the global cancer deaths [1]. Hepatocellular carcinoma (HCC) is the most commonly observed histological subgroup of primary liver cancer, accounting for 70–90% of the cases. With a global status quo that 746,000 deaths only in 2012 and 10.1 new cases diagnosed within every 10,000 people, HCC ranks the sixth lethal malignancy and the third leading cause of cancerrelated deaths [2].

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and eproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Over the past decades, the clinical approaches to treat liver cancer have considerably evolved. Patients can benefit from partial hepatectomy, radiotherapy, systemic or local chemotherapy, liver transplantation, and radiofrequency ablative surgery. Nevertheless, numerous adverse events and dismal outcomes still seriously affect the life quality of patients. On the background of shortcomings, developing improved preventive and therapeutic strategy is urgently necessary.

and metastasis, chemotherapeutic resistance, and so on. Chinese medicine, in various forms including composite formulae, extracted fractions, monomers, and their derivatives, has been

What Chinese Medicine Can Do for Liver Cancer? http://dx.doi.org/10.5772/intechopen.80061 115

Berberine is a natural product in many Chinese medicinal herbs, especially Coptidis rhizoma, which has been extensively studied and reported to show the antitumor action mostly by modulation of a number of different signal transductions. Currently, scholars have explored the antitumor action of berberine in liver cancer by various different strategies. For instance, in our laboratory, we found that berberine-induced cell death and tumor growth inhibition in xenograft model were demonstrated and mechanism was revealed that miR-23a might play a mediated role in berberine-suppressing HCC growth [10]. Also, cyclin D1 overexpression is mainly responsible for tumor expansion, metastasis as well as angiogenesis. Berberine was found to repress the expression of cyclin D1 via proteasomal degradation in HCC [11]. In addition, our group identified that berberine exerted antimigratory and anti-invasive abilities in HCC cells involving the upregulation of PAI-1 and downregulation of uPA [12]. On the other hand, our group described for the first time that berberine could trigger autophagic cell death, in which the compound was shown to activate Beclin-1 and suppress mTOR [13]. Actually, lung metastases in liver cancer are also a serious problem for patients, and we identified that the anti-invasive and antiproliferative actions of berberine in liver cancer was at least in part involved in the downregulation of Id-1, revealing a new anti-invasive mechanism [14]. Hence, berberine is

Flavonoids commonly exist in Chinese medicine and could be isolated from many different kinds of herbal medicine. In recent years, the precise molecular mechanism underlying the obvious antiliver tumor effect of flavonoids has been studied. For example, hydroxysafflor yellow A (HSYA), a kind of flavonoid extracted from Carthamus tinctorius L. owns the ability of antitumor. It was demonstrated that HSYA could result in angiogenesis inhibition of HCC by blocking signaling pathways of ERK/MAPK and NF-κB in comparison with negative control group. More interestingly, spleen and thymus indexes have been demonstrated to be improved, suggesting improvement on the immune system by HSYA [15]. Oroxin B (OB) is one of the flavonoids isolated from Oroxylum indicum (L.) Vent. Li et al. investigated the antitumor effects of OB on HCC cell line SMMC-772 and studied the underlying mechanisms by which OB markedly inhibited expansion and induced apoptosis of the HCC cells. The antitumor activity of OB probably involved the inhibition of COX-2/VEGF and PTEN/PI3K/AKT signaling pathways, providing evidence for OB being used as a new therapeutic agent for liver cancer [16]. Another flavonoid, namely luteolin, showed antineoplastic activity in a number of cancer cells. In SMMC-7721 HCC cells, luteolin induced apoptosis partially via modulation of autophagy, indicating

Brucein D (BD) is an active constituent derived from Brucea javanica fruit, which has been employed as an antitumor recipe in Chinese medical practice. It was revealed that BD exerted observable apoptotic induction in HCC in vitro and in vivo, which was attributed to the

pursued as ideal and novel sources for therapeutic agent development for cancer.

2.1. Single compounds from Chinese medicine for the treatment of liver cancer

predicted as a new and potent natural molecule targeting liver cancer.

luteolin serving as a regulator of autophagy in treating liver cancer [17].

reduced expression of miR-95 [18].

Considering its low toxicity and high activity, Chinese medicine has been deemed as one of the prominent complementary and alternative approaches in tumor therapy. As unique biomedical and pharmaceutical resources, Chinese medicine owns the ability of providing better treatment for liver cancer, either alone or in integrative way [3]. According to Hong Kong Liver Cancer staging system in a population-based investigation, for patients with Va/Vb (tumor status being early, intermediate or locally advanced), the most frequent treatment was Chinese medicine [4]. Another cohort study in Taiwan reported that Chinese medicine users exhibited significant lower risk to suffer HCC, which supported the application of Chinese medicine into the clinical practice of liver cancer treatment [5]. A recent meta-analysis showed that add-on therapy with Chinese medicine regimens in HCC could reduce side effects, activate tumor responses, and improve overall survival. Moreover, cancer subjects were reported to be more inclined to integrating Chinese medicine regimens with conventional therapies rather than conventional treatment only [6]. In this regard, Chinese medicine has been considered as a potential curative choice of method for controlling the proliferation of liver cancer, and thus improving the quality of life and prolonging overall survival of the patients.

Historically, the medical foundation of Chinese medicine can be traced back to 5000 years ago. With contributions and dedications of Chinese medical people in modern and old times, Chinese medicine has been gradually evolved and accepted by the mainstream society. In particular, accompanying the tide of Chinese immigration and cultural communication, Chinese medicine has been approved worldwide and employed in clinical practice in at least 183 countries [7]. Even though many regions have the regulations imposing restrictions to ensure that Chinese medicine is beneficial to liver cancer patients instead of being harmful to public health, the evidence-based guideline has not been covered every field [8, 9].

However, due to its effective curative outcomes in real life, the usage of Chinese medicine in various forms of single compounds, extracted fractions, and composite formulae has attracted a great deal of attentions over the past few decades. Chinese medicine may be capable of retarding liver cancer progression with its multitargets and coordinated intervention actions, either in combination with conventional therapies or radiation alone. Here, we retrospectively reviewed and analyzed the functional roles of Chinese medicine in the treatment of liver cancer.
