Ginger in Combination with Traditional Antiemetics Prevents CINV

Ginger (Zingiber Officinale) has been used since ancient times for medicinal purposes, including as a treatment for nausea and vomiting, as it is well-absorbed by the body and appears to have anti-inflammatory effects. In 2006, a retrospective review published in the British Medical Journal of six randomized clinical trials found that ginger was superior to placebo and as effective as the antiemetic metoclopramide (Reglan, Octamide, Maxolon) in controlling nausea in a variety of patients, including those on chemotherapy. Since then, several studies have been published on ginger as a potential treatment for chemotherapy-induced nausea and vomiting (CINV); these have demonstrated inconsistent but often promising results. Now, in the largest study to date, presented by Julie Ryan, PhD, MPH, assistant professor of dermatology and radiation oncology at the University of Rochester, ginger in combination with a 5-HT3 receptor antagonist antiemetic was found to significantly reduce CINV in patients with cancer. This is the first study to examine the effects of ginger supplementation on nausea before the administration of chemotherapy.

The phase II/III randomized, placebo-controlled, double-blind clinical trial included a total of 664 patients who had experienced nausea after a chemotherapy cycle and were scheduled to receive at least three additional cycles at a University of Rochester-affiliated Community Clinical Oncology Program (CCOP) member site. Patients had a mean age of 53 years, and 90% were women. The most common cancer types were breast (66%), alimentary (6.5%), and lung (6.1%). Patients were randomized into four arms: placebo, 0.5g ginger, 1.0g ginger, or 1.5g ginger. On day 1 of any chemotherapy treatment cycle, all patients received 5-HT3 receptor antagonist antiemetics and took three 250mg capsules of ginger or placebo twice daily for 6 days starting 3 days before the first day of the next two cycles.

For days 1 to 4 of each cycle, patients were required to report the severity of their nausea during the morning, afternoon, evening, and night using a seven-point semantic rating scale, with 1 indicating “Not at all Nauseated” and 7 indicating “Extremely Nauseated.” Analysis of covariance (ANCOVA) was used to assess change in nausea in the four study arms on day 1 of cycles 2 and 3. The investigators found that all doses of ginger significantly reduced nausea (P = .003); however, the greatest reduction in nausea was observed in those receiving 0.5g and 1.0g of ginger. The time of day also had a significant effect on nausea (P < .001), with a linear decrease being observed over 24 hours for patients using ginger.

Take-home message

The study findings indicate that ginger supplementation at daily doses of 0.5g to 1.0g may significantly reduce nausea during the first day of chemotherapy and may be considered as a treatment in combination with traditional antiemetics; however, while ginger is on the FDA's “generally recognized as safe” list, it can interact with certain medications, such as warfarin. As with all supplements, physicians should consider all medications that their patients are on before prescribing ginger.

Abstract 9511

Disclosures: The study was supported by NCI PHS grants 1R25CA10618 and U10CA37420.