Astragalus
Also called: Astragalus membranaceus, huang qi.
Last reviewed 2026-09-16. How this works.
Added to chemotherapy in lung cancer Grade C
Human evidence exists and does not settle it.
Many trials report a benefit, the people who gathered them say the trials were poor, and nobody has checked since.
Many randomised trials from one region, poor quality by the authors' own account.
The claim
The claim is that astragalus-based herbal preparations added to platinum chemotherapy improve survival and reduce side effects in advanced lung cancer.
What it does
Immune effects are proposed. This entry turns on the quality of the trials rather than on the mechanism.
The evidence
A meta-analysis of randomised trials reported that astragalus-based herbal medicine may increase the effectiveness of platinum chemotherapy, with improvements in survival, tumour response and performance status and reduced toxicity.1
Its own authors are the first witnesses against it. They state that because the studies found were of poor quality they are unable to make firm conclusions, and that confirmation must await rigorously controlled trials.1
A published letter argued that the meta-analysis carried important bias, with a reply from the authors. The chapter note records that neither the letter nor the reply has been read, only the citation, so the register states that the exchange exists and not what it says.2
Later work reports an overall survival hazard ratio of 0.61 and a separate pooling of 65 trials across 4,751 patients. Effect sizes larger than most licensed cancer drugs achieve, from trials the original reviewers called poor, twenty years after they asked for confirmation that has not come.3
The studies this rests on
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Meta-analysis of astragalus-based herbs with platinum chemotherapy in advanced lung cancer1
A meta-analysis, summarising randomised trials, measured survival.
reported improved survival, tumour response and performance status; the authors record the studies as poor quality.
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Systematic review of astragalus-containing traditional Chinese medicine with chemotherapy3
A meta-analysis, summarising randomised trials, measured survival, 4751 participants.
reported overall survival hazard ratio favouring the addition of astragalus.
hazard ratio 0.61, interval 0.42 to 0.89. overall survival, P=0.011
What is absent
The rigorous confirmation the 2006 reviewers explicitly asked for has not been conducted in the twenty years since.
Scope: outside the region of origin.
Established by published review, Journal of Clinical Oncology 2006;24(3):419-430, checked 2026-09-16. Result: the authors state that confirmation must await further rigorously controlled investigation.13
What to ask
When many trials from one place all agree, what would make you more confident in the result?
The dish-to-person gap
The register holds no human pharmacokinetic measurement for astragalus against any laboratory concentration.
When to call your team — no warning signs are recorded
Whatever you are taking or thinking of taking, the people treating you can only weigh it if they know about it. That is true when nothing has been written down here, and it is most true then.
The register records no warning signs for astragalus. That is not a statement that nothing can go wrong.
Interactions
The register holds no measured interaction between astragalus and a cancer treatment class. An empty list means nobody has measured it.
Nobody having looked is not the same as nothing being there. That is what this line says and all it says.
The whole interaction list, and how to turn it into a pharmacy review request.
Find a trial instead
The confirmation the original authors asked for twenty years ago has not happened, and a trial is where it would.
Search ClinicalTrials.gov for recruiting studies of astragalus
A trial is the same decision with monitoring, a known preparation and a doctor who knows what else you are taking.
References
McCulloch M, See C, Shu XJ, Broffman M, Kramer A, Fan WY, Gao J, Lieb W, Shieh K, Colford JM Jr. Astragalus-based Chinese herbs and platinum-based chemotherapy for advanced non-small-cell lung cancer: meta-analysis of randomized trials. Journal of Clinical Oncology 2006;24(3):419-430.
doi:10.1200/JCO.2005.03.6392 · PubMed 16421421
How this was reached: transcribed from chapter note, via docs/CHAPTER-NOTES.json, chapter 18 note 8.
Firenzuoli F, Gori L, Di Simone L, Morsuillo M. Important bias in the Astragalus meta-analysis. Journal of Clinical Oncology 2006;24(19):3215-3216, with author reply at 3216-3217.
How this was reached: transcribed from chapter note, via docs/CHAPTER-NOTES.json, chapter 18 note 9.
Astragalus-containing traditional Chinese medicine, with and without prescription based on syndrome differentiation, combined with chemotherapy for advanced non-small-cell lung cancer: a systematic review and meta-analysis. Current Oncology 2016.
How this was reached: transcribed from chapter note, via docs/CHAPTER-NOTES.json, chapter 18 note 10.