Home > Trending on TAP > December 2019 > Epigallocatechin-3-Gallate (EGCG) for Radiation-Induced Esophagitis

Epigallocatechin-3-Gallate (EGCG) for Radiation-Induced Esophagitis

12/17/2019 3:50:49 PM
lung cancerLocally advanced lung cancer often requires sequential or concurrent chemoradiotherapy. This combination therapy can cause severe side effects that prolong or interrupt the treatment. One of the most common side effects of chemoradiotherapy in patients with lung cancer is acute radiation-induced esophagitis (ARIE). Symptoms of ARIE include pain, dysphagia, nausea, and anorexia. Severe ARIE can lead to dehydration, malnutrition, and weight loss. 
The standard treatment for ARIE is a mixture of drugs that includes lidocaine, dexamethasone, and gentamicin (mLDG). However, epigallocatechin-3-gallate (EGCG) has also been investigated as a potential alternative treatment for radiation-induced esophagitis.

Study examines EGCG for lung cancer

Researchers affiliated with Shandong University in China previously conducted a phase I study that demonstrated the feasibility and safety of EGCG in patients with locally advanced lung cancer. Then they conducted a single-arm phase II study to assess the efficacy of EGCG for ARIE. Most recently, they conducted a randomized controlled trial of EGCG for the prevention and treatment of ARIE. The results were published in Radiotherapy and Oncology in 2019. 
Eighty-three patients, receiving sequential or concurrent chemoradiotherapy for lung cancer, participated in the trial. Patients were randomized to one of 3 groups: group A received EGCG in 0.9% saline solution orally from the start of radiotherapy; group B was given EGCG in 0.9% saline solution as soon as grade I esophagitis occurred during radiation; and group C was given standard therapy (mLDG solution) as soon as grade I esophagitis occurred during radiation. The primary objective of the study was to determine if EGCG was more effective than conventional therapy for preventing or reducing ARIE.
EGCG was provided by NINGBO HEP Biotech Co., Ltd., in a concentration of 440 micromol/L (equivalent to 200mg EGCG). Patients were given 10 mL 3 times per day (6mg EGCG per day), which they consumed by repeated swallowing to maximize the exposure to the esophageal wall.

EGCG possible radioprotectant for lung cancer patients

The difference in the maximum grade of ARIE among the 3 groups was statistically significant. The maximum ARIE for patients with EGCG (groups A + B) was significantly lower than for those with conventional therapy (group C). The mean ARIE for group A was lower than that of group B (p=.028), and the mean ARIE for group B was lower than that of group C (p=.002). Also, the pain index and dysphagia index were significantly lower in patients receiving EGCG than in those receiving standard treatment.
Importantly, there was no difference in the response rates to chemoradiation among the 3 groups. EGCG did not interfere with the efficacy of treatment. The authors of this study concluded that “EGCG could be safely used as a radioprotectant for patients undergoing radiotherapy.”
Zhao H, Jia L, Chen G et al. A prospective, three-arm, randomized trial of EGCG for preventing radiation-induced esophagitis in lung cancer patients receiving radiotherapy. Radiother Oncol. 2019; 137: 186-191.