For Patients & Caregivers
Proteolytic enzymes have not been shown to treat cancer.
Proteolytic enzyme (PE) treatments were first used in Germany in the 1960s for inflammation, osteoarthritis, autoimmune diseases, and viral infections. The products usually contain a mixture of pancreatin, papain, bromelain, trypsin, and chymotrypsin. Laboratory studies have shown that PEs can affect the growth of cancer cells. Although PEs were reported to benefit patients with cancer, recent studies do not support such claims.
Observational studies suggest beneficial effects but clinical data are lacking.
- Autoimmune diseases
This use is not backed by clinical data.
- Viral infections
There is no scientific evidence to support this use.
- Cancer and treatment-related symptoms
Data from some studies suggest benefit, but more recent randomized controlled trials do not confirm this.
- Hepatitis C
This use is not supported by scientific evidence.
For Healthcare Professionals
Proteolytic enzyme (PE) treatments were first popularized in Germany in the 1960s for inflammation, osteoarthritis, autoimmune diseases, and viral infections. The products usually contain a mixture of pancreatin, papain, bromelain, trypsin, and chymotrypsin. Studies done in vitro and in mice have shown that PEs have immunomodulatory and tumoricidal properties (1) (2) (3) (4) (5) (6). Such effects are thought to result from degradation of abnormal immune complexes.
Oral administration of PEs to healthy volunteers resulted in immunomodulatory effects (7). Although some clinical and epidemiological studies suggest beneficial effects with adjuvant PEs in patients with head and neck cancers (8), multiple myeloma (9), breast cancer (10), and cervical cancer (11), conflicting data do not support the findings (12). A randomized controlled trial also determined there is insufficient evidence that these enzymes can prevent mucositis (13). Further, results from a study involving patients with inoperable pancreatic cancer showed a decrease in overall survival and poorer quality of life with PEs compared with standard gemcitabine-based chemotherapy (14).
PEs are thought to exert immunomodulatory effects by causing increased release of reactive oxygen species by polymorphonuclear leukocytes (7) or by production of tumor necrosis factor-alpha and interleukins IL-6 and IL-1B that cause cytotoxic effects (1) (2). The antiangiogenic effects that the constituent papain exhibits in VEGF-activated human endothelial cells is concentration-dependent and likely due to interference with AKT, MEK1/2 and SAPK/JNK phosphorylation (15). Bromelain has been shown to lower the tumorigenic/metastatic capacities of sarcoma L-1 cells (3). It also inhibited glioma cell migration and invasion by affecting expression of integrins, necessary for cellular migration and invasion (5). In B16 murine melanoma models, PEs inhibited metastasis by reducing expression of CD44 and CD54 molecules (6).