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MS-N163 · Botanical extract · Cognitive support · Breast cancer · Double-blind phase III trial · Appraised 28 October 2026

Does standardized Ginkgo biloba extract prevent cognitive decline during and after adjuvant chemotherapy for breast cancer?

Evidence at a glance

  • Evidence label: Negative phase III trial
  • Benefit: No objective or self-reported cognitive benefit was detected through treatment and follow-up.
  • Certainty: Moderate. The multicenter trial was randomized and double blind, but 166 of 210 treated participants contributed to the primary analysis.
  • Risk: The trial excluded antithrombotic therapy and found no bleeding signal, but ginkgo can increase bleeding risk with anticoagulants and may interact with other medicines.

What was studied

Previously chemotherapy-naive women starting adjuvant breast-cancer chemotherapy received EGB 761 Ginkgo biloba extract 60 mg twice daily or matching placebo, beginning before cycle 2 and continuing through chemotherapy plus one month. Twenty-three U.S. centers enrolled 226; 210 began study treatment and 166 provided primary-analysis data. The High Sensitivity Cognitive Screen area under the curve through 12 months was primary.

What the evidence found

There was no significant difference in the primary cognitive AUC, Trail Making Tests A or B, perceived cognitive function, confusion or mood at the end of chemotherapy or later measured time points. Toxicities were similar; no bleeding signal emerged in this selected population.

How to interpret it

This high-quality negative trial addresses prevention with one standardized extract. A 2025 uncontrolled cohort used a different ginkgo ketone ester product and cannot overturn the randomized result. Neither study supports using ginkgo as a cancer treatment.

Practical safety context

Review ginkgo with the oncology pharmacist before chemotherapy, surgery or anticoagulant/antiplatelet treatment. Stop and seek advice for unusual bruising or bleeding. Products vary, and the EGB 761 dose should not be generalized to other extracts.

Questions for the care team

  • Am I taking an anticoagulant, antiplatelet drug or medicine with a narrow therapeutic index?
  • Could sleep, mood, anemia, menopause or other reversible factors explain cognitive symptoms?
  • Would structured cognitive rehabilitation or exercise have better evidence for my situation?

Funding and conflicts

The extract and matching placebo were supplied by Schwabe Pharmaceuticals; the study was conducted through the North Central Cancer Treatment Group. Full-text conflict details did not identify an efficacy advantage for the supplied product.

Sources

Last literature search: 28 October 2026. Record appraisal: 28 October 2026. This page is educational and does not replace individualized medical advice. Symptom, biomarker or observational findings must not be interpreted as proof of tumor control, recurrence prevention or longer survival unless those outcomes were directly tested.