For Patients & Caregivers
Bottom Line: 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.
A total of 55 patients with inoperable pancreatic cancer were enrolled in this controlled, observational study. Twenty-three patients chose gemcitabine-based chemotherapy, and 32 chose enzyme treatment that consisted of pancreatic enzymes, nutritional supplements, detoxification, and an organic diet. The two groups had no significant differences in quality of life or pathology at enrollment. At the 1-year time point, researchers observed an increase in overall survival and better quality of life in patients who chose gemcitabine-based chemotherapy compared with those in the PE group.
Radiation Treatment Symptoms
A total of 69 patients were enrolled in this randomized controlled trial to see if PEs could treat the side effects associated with head and neck radiation, such as mouth ulcers and inflammation. Although PEs were well tolerated, there was no difference among those who took the enzymes, the placebo, or those who did not receive anything while undergoing radiation. In addition, radiation side effects started earlier in the PE group.
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 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).
Chabot JA, et al. Pancreatic proteolytic enzyme therapy compared with gemcitabine-based chemotherapy for the treatment of pancreatic cancer. J Clin Oncol. 2010 Apr 20;28(12):2058-63.
This controlled, observational study evaluated PE therapy compared with gemcitabine-based chemotherapy in patients with inoperable pancreatic cancer. Of 55 enrolled patients, 23 chose chemotherapy and 32 elected enzyme treatment that consisted of pancreatic enzymes, nutritional supplements, detoxification, and an organic diet. The two groups had no statistically significant differences in quality of life or pathology at enrollment. At 1-year time point, researchers observed an increase in median overall survival (9.7 mo) and better quality of life (P<.01) in patients who chose gemcitabine-based chemotherapy compared with those in the PE group.
Dorr W, Herrmann T, Study G. Efficacy of Wobe-Mugos E for reduction of oral mucositis after radiotherapy: results of a prospective, randomized, placebo-controlled, triple-blind phase III multicenter study. Strahlenther Onkol. 2007;183:121-127.
This prospective, randomized, placebo-controlled, triple-blind phase III multicenter study evaluated the efficacy and safety of PEs (Wobe-Mugos® E containing papain 100 mg, trypsin 40 mg, and chymotrypsin 40 mg) to treat side effects associated with head-and-neck radiotherapy (RT) including oral mucositis. A total of 69 patients were enrolled, with 61 evaluable patients. The primary endpoint was the maximum mucositis score during weeks 1–6 of RT. Although the intervention was well tolerated, there were no between-group differences in the primary endpoint results. However, the intervention appeared to result in an earlier onset of mucositis, thus increasing the average scores over treatment duration. Investigators concluded the PE therapy did not confer any benefit for patients with RT-induced early oral mucositis.