Interaksi Obat-Herbal dengan Agen Hormon dalam Terapi Kanker: Tinjauan Mekanisme dan Implikasi Klinis
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Terapi hormon merupakan landasan penanganan kanker yang bergantung pada hormon, seperti kanker payudara dan prostat. Di sisi lain, tingginya angka penggunaan obat herbal sebagai pengobatan komplementer pada pasien kanker berpotensi menimbulkan interaksi obat-herbal (HDI), yang dapat mempengaruhi efikasi dan keamanan terapi utama. Kajian ini bertujuan untuk mengidentifikasi dan mengkategorikan interaksi obat-herbal (HDI) pada terapi hormon kanker berdasarkan mekanisme farmakokinetik (meliputi modulasi enzim CYP450 dan transporter obat) dan farmakodinamik (meliputi modulasi reseptor hormon dan jalur sinyal), serta menyimpulkan implikasi klinisnya. Tinjauan sistematis dilakukan mengikuti panduan PRISMA-ScR. Pencarian literatur dilakukan pada database PubMed, Scopus, ScienceDirect, Frontiers, dan Google Scholar untuk studi in silico, in vitro, dan in vivo yang relevan, yang diterbitkan antara tahun 2015 hingga 2025. Analisis menunjukkan bahwa HDI dapat dikategorikan menjadi dua kelompok utama. Pertama, interaksi farmakokinetik yang terjadi melalui modulasi enzim sitokrom P450 (CYP) dan transporter obat, misalnya penurunan ketersediaan hayati tamoxifen oleh Hedyotis diffusa. Kedua, interaksi farmakodinamik pada reseptor hormon, seperti efek sinergis antara Boswellia serrata dan enzalutamide. Sifat interaksi sangat bervariasi, dari antagonis hingga sinergis, tergantung pada pasangan herbal-obat tertentu. Temuan ini menekankan pentingnya kewaspadaan klinis seperti komunikasi terbuka dengan pasien, penyesuaian dosis, pemantauan terapeutik dan kolaborasi interprofesional. Langkah-langkah ini diperlukan untuk mengurangi risiko HDI dan meningkatkan efikasi terapi kanker.
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