Record ID: MS-N097
Family: Repurposed plant-derived medicines
Clinical question: Does short-course oral artesunate before colorectal-cancer surgery improve tumor biology or cancer outcomes?
Evidence label: Very small randomized pilot; investigational only
Evidence at a glance
Benefit: The primary apoptosis comparison was not clearly persuasive; exploratory Ki-67 and recurrence signals justify research, not treatment.
Certainty: Very low because only 23 people were randomized and 20 completed per protocol.
Risk: Short-course artesunate was generally tolerated, but neutropenia was reported and anticancer use is not established.
Cancer control: No reliable evidence establishes reduced recurrence or longer survival.
What was studied
A single-center double-blind pilot randomized 23 people awaiting curative colorectal-cancer resection to oral artesunate 200 mg/day or placebo for 14 days before surgery. Twelve were assigned artesunate and 11 placebo; nine and 11, respectively, completed per protocol.
The primary endpoint was the proportion of tumors with apoptosis in more than 7% of cells. Secondary endpoints included Ki-67 and other tissue markers, plus exploratory clinical follow-up.
What the results mean
Apoptosis above the prespecified threshold occurred in 67% of artesunate and 55% of placebo participants. Exploratory Bayesian analyses favored a reduction in Ki-67.
At a median 42 months, recurrence was reported in 1 artesunate recipient and 6 placebo recipients. With so few patients and an exploratory clinical comparison, this cannot establish recurrence prevention or justify off-label self-treatment.
Limits and uncertainty
The trial was a feasibility/pilot study with substantial imprecision, incomplete per-protocol participation and multiple biomarker analyses. The primary biological endpoint was not a patient-centered outcome.
Preclinical antitumor findings and an antimalarial indication do not prove effectiveness or safety as cancer therapy.
Safety and practical context
The report described artesunate as generally tolerated but noted neutropenia. Longer exposure, combinations with chemotherapy and nonpharmaceutical products may have different risks.
Artesunate should not replace surgery, chemotherapy or surveillance. Any anticancer use belongs in a regulated clinical trial with drug-quality assurance and blood-count monitoring.
Questions for the care team
- Was the claim based on apoptosis, Ki-67 or an adequately powered recurrence endpoint?
- Is pharmaceutical-grade drug and hematologic monitoring available in a trial?
- Could treatment delay compromise planned surgery?
- What confirmatory human study has reproduced the signal?
Sources
Funding and conflicts
Complete funding and conflict details should be checked in the full paper. Repurposing interest does not substitute for confirmatory efficacy trials or pharmaceutical-quality controls.
Last literature search: October 21, 2026
Record appraised: October 21, 2026
This educational record is not individualized medical advice. Research doses and schedules are not personal prescriptions; do not delay or replace evidence-based cancer care.
