Efficacy and safety of American ginseng-based therapies for cancer: a systematic review and meta-analysis

To systematically evaluate the efficacy and safety of American ginseng (AG, Panax quinquefolius L.)-based cancer therapies and assess the certainty of the available evidence.

We searched the China National Knowledge Infrastructure, Wanfang, Chinese Scientific Journals Database, SinoMed, PubMed, Embase, and the Cochrane Library databases from inception until December 8, 2025, and updated the search through June 30, 2026, for randomized controlled trials (RCTs) evaluating AG-based therapies for malignant tumors. Two reviewers independently selected studies, extracted data, assessed risk of bias using the Cochrane Risk of Bias 2 tool, and assessed evidence certainty using the Grading of Recommendations Assessment, Development and Evaluation (GRADE)pro guideline development tool. Disagreements were resolved by consultation with a third reviewer. Meta-analyses, data visualization, and sensitivity analyses were performed using R software.

The meta-analysis included 15 RCTs involving 1415 participants (intervention group: 857 participants; control group: 558 participants). Pooled analyses of traditional Chinese medicine (TCM) formulations containing AG suggested a higher objective response rate (ORR) when combined with conventional medical treatment (CMT) (risk ratio [RR] = 1.39, 95% confidence interval [CI]: 1.04, 1.85) and a higher disease control rate (DCR) when administered alone or in combination with CMT (RR = 1.21, 95% CI: 1.10, 1.33). A higher proportion of patients receiving AG-containing TCM formulations met the study-defined criterion for improved Karnofsky Performance Status (KPS) (RR = 2.62, 95% CI: 1.63, 4.21). Pooled estimates also favored AG-containing TCM formulations plus CMT for chemotherapy-related leukopenia, gastrointestinal reactions, hepatic dysfunction, and alopecia, although several of these estimates were based on a small number of studies. The certainty of evidence across outcomes was low or very low.

Although several pooled estimates favored AG-containing TCM formulations, the certainty of the available evidence was low to very low certainty. Therefore, our findings should be considered exploratory rather than confirmatory.

This study was registered with the International Prospective Register of Systematic Reviews (https://www.crd.york.ac.uk/PROSPERO/, CRD420261419243).