How a Compound from Traditional Chinese Medicine Fights Liver Cancer: Understanding Astragaloside-IV (AS-IV) Therapy for Hepatocellular Carcinoma

Table of Contents

• Key Points
• Background: Why Liver Cancer Needs New Treatments
• What Is Astragaloside IV?
• How This Review Was Conducted
• Which Studies Were Included
• How Reliable Are These Studies? (Risk of Bias)
• Key Finding 1: AS-IV Blocks Cancer Cell Growth (Proliferation)
• Key Finding 2: AS-IV Slows Spread and Invasion (Metastasis)
• Key Finding 3: AS-IV Triggers Programmed Cell Death (Apoptosis)
• Key Finding 4: AS-IV Helps the Immune System Fight the Tumor
• Key Finding 5: AS-IV Reverses Drug Resistance and Boosts Chemotherapy
• Key Finding 6: AS-IV Blocks New Blood Vessel Growth (Angiogenesis)
• Additional Mechanisms: Scar Tissue, Oxidative Stress, and Tumor Metabolism
• What This Means for Patients
• Limitations: What This Review Could Not Prove
• Practical Recommendations
• Frequently Asked Questions
• Source Information

Key Points

• All 16 reviewed studies of astragaloside IV in hepatocellular carcinoma were done in cancer cells, animals, or both; no human trials were found.
• In those studies, astragaloside IV blocked growth, spread, and invasion, triggered apoptosis, aided immune response, and reduced drug resistance.
• The review found widespread unclear risk of bias, especially for blinding, and wide differences in cell lines, animal models, doses, and durations.
• No effective or safe human dose is established; cell and mouse doses cannot simply be translated into a human regimen.
• Do not use astragaloside IV or Astragalus to treat liver cancer; talk to your oncology team before any herbal product.

Background: Why Liver Cancer Needs New Treatments

Hepatocellular carcinoma (HCC — the most common type of primary liver cancer) is the sixth most common cancer worldwide. It also ranks among the top three causes of cancer-related death when measured by disease burden. The World Health Organization's International Agency for Research on Cancer estimates that in 2022 alone, HCC caused more than 870,000 new cases and 760,000 deaths globally.

Treatment for HCC has improved in many ways. Doctors now use better surgical techniques and more precise radiation therapy. Doctors also use newer chemotherapy drugs. Doctors use targeted therapies that attack specific molecular weak points in cancer cells. Doctors use immunotherapy that trains the immune system to fight the tumor. Hospitals also rely on multidisciplinary teams, where surgeons, oncologists, radiologists, and other specialists plan care together.

Despite these advances, survival for patients with advanced HCC remains poor. Improvements in long-term outcomes have been limited. High recurrence rates (the cancer coming back) and the risk of distant metastasis (spread to other organs) make the disease especially hard to manage. This creates what the authors call a "treatment–relapse–retreatment" vicious cycle, which places an immense burden on patients' families and on healthcare systems. As a result, finding new anticancer agents has become an urgent priority.

Plants have long been a source of cancer drugs. The authors highlight two examples. Paclitaxel, extracted from the bark of the Pacific yew tree (Taxus brevifolia), is now a core drug in combination chemotherapy for breast cancer, ovarian cancer, and non-small cell lung cancer. Berberine, an alkaloid from the traditional Chinese medicine Coptis chinensis, prevented the recurrence of colonic adenomas (pre-cancerous growths in the colon) in a randomized controlled trial. Plant-derived compounds often act on multiple targets and multiple biological pathways at once. That makes them attractive candidates for HCC research.

Traditional Chinese medicine (TCM) has drawn growing international interest in comprehensive cancer care. The reasons cited are its multi-target regulatory effects, low toxicity, and favorable tolerability. The authors argue that plant-based therapies hold broad prospects for cancer treatment.

What Is Astragaloside IV?

Astragalus membranaceus (known in Chinese medicine as Huangqi) is a classic herb with a history spanning more than a thousand years. It was first documented in the Shennong Bencao Jing (the Divine Farmer's Classic of Materia Medica), where it was classified as a superior Qi-tonifying herb. In TCM theory, its immune-modulating effects are described by the principle of "strengthening vital Qi and stabilizing constitutional integrity." Modern pharmacology has extensively studied and confirmed these effects.

Astragalus contains many bioactive compounds, including saponins, flavonoids, and polysaccharides. Its most distinctive component is astragaloside IV (AS-IV). Chemically, AS-IV is a lanostane-type tetracyclic triterpenoid saponin (a category of plant-derived molecules with a four-ring chemical backbone). Researchers Kitagawa and colleagues first isolated and structurally characterized it from Astragalus roots in 1983. Today, AS-IV is recognized as the official quality marker for Astragalus in the Chinese Pharmacopoeia.

Its full chemical designation is 3-O-β-D-xylopyranosyl-6-O-β-D-glucopyranosyl-cycloastragenol, with the molecular formula C₄₁H₆₈O₁₄. The review includes a figure showing AS-IV's chemical structure.

AS-IV is not only the main bioactive compound behind Astragalus's pharmacological effects. It has also shown remarkable therapeutic activity in several areas. These areas are protecting the heart and blood vessels (cardiovascular protection) and protecting the liver and kidneys (hepatorenal preservation). They also include easing complications of diabetes and fighting tumors. In cancer research specifically, evidence is accumulating that AS-IV has potent inhibitory effects across multiple cancer types. Recent studies suggest it has strong anti-HCC activity acting through many different molecular mechanisms — but the exact pathways remain incompletely understood. That gap is what this review set out to fill.

How This Review Was Conducted

This is a systematic review — a structured, transparent summary of all existing research on a specific question. The authors followed two internationally recognized standards: the PRISMA 2020 guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and the Cochrane Handbook for Systematic Reviews of Interventions.

Two researchers, XG and WH, independently searched five authoritative databases: PubMed, Cochrane, EMBASE, the China National Knowledge Infrastructure (CNKI), and Wanfang Data. They looked for studies published from each database's inception through March 2025.

The search keywords were "astragaloside IV" and "Hepatocellular carcinoma," combined with additional terms including:

• "astraloside," "ASIV," "astragalus," "astragaloside," "AS"
• "Huangqi" (the Chinese name for Astragalus)
• "Hepatoma," "Hepatic Neoplasm," and "liver cancer"

The team also manually reviewed the reference lists of relevant papers to ensure no eligible article was missed.

Which studies qualified — and which did not

Inclusion criteria (studies had to meet all of these):

1. The experimental drug had to be AS-IV.
2. The experimental group had to consist of animals treated with AS-IV alone. The control group could not receive any other pharmacological intervention.
3. The experimental subjects had to be either hepatocellular carcinoma cells or animals with confirmed HCC created through appropriate modeling techniques.

Exclusion criteria (any one of these disqualified a study):

1. Reviews, abstracts, reports, or letters.
2. Studies with incomplete or duplicate data.
3. Studies where the experimental group received AS-IV combined with other drugs.

Two researchers extracted the data independently, resolving any disagreements by discussion until they reached consensus. The data collected from each study included: authors, cell types used, animal species, drug dosage, drug exposure time, and the molecular mechanisms of AS-IV in treating HCC.

Which Studies Were Included

The database searches retrieved 172 potentially relevant articles. A further 9 relevant reports were identified through manual searching, bringing the total to 181 records.

The screening process then proceeded step by step:

• 36 duplicate papers were removed, leaving 145 papers.
• 145 papers were screened by title and abstract. Of these, 110 were deemed irrelevant, leaving 35 papers for full-text review.
• 19 records were excluded after full-text reading.
• 16 studies met all eligibility criteria and underwent final analysis.

Each step of the selection process was conducted independently and cross-checked by two investigators.

Among the 16 included studies, the design break-down was:

• 1 study performed only in vivo (living animal) experiments.
• 8 studies performed only in vitro (laboratory cell) experiments.
• 7 studies used both in vivo and in vitro approaches.

Details of the 16 included studies

How Reliable Are These Studies? (Risk of Bias)

Before trusting results, a systematic review must check each study for risk of bias — meaning flaws in how the experiment was designed or reported that could make the findings look better or worse than they really are. The authors used two separate tools because the studies used two different types of experiments.

For the 15 in vitro (cell-based) experiments, the team used the OHAT Risk of Bias Tool. The results:

• Appropriate comparison groups and other bias: all studies were rated low risk. This is a positive signal.
• Blinding of outcome assessment (whether the people measuring results knew which group was which): all studies were rated as unclear risk. Blinding is often impractical in cell experiments, but it leaves uncertainty.
• Adequately randomized dose or exposure level and selective reporting: most studies were rated low risk.
• Adequate allocation of study groups: 6 studies were rated unclear risk; the rest were low risk.
• Accounting for important confounding and modifying variables (factors that could distort the results): 8 studies were rated unclear risk; the rest were low risk.

For the in vivo (animal) experiments, the SYRCLE Risk of Bias Tool was used. The results were more mixed:

• Other bias was considered low risk in all studies.
• Random housing was deemed to have an unclear risk of bias across the board.
• Half of the studies were rated as unclear risk for both random sequence generation (how animals were assigned to groups) and random housing.
• Five studies each were rated unclear risk for baseline characteristics (whether groups started out comparable), allocation concealment (hiding which treatment each animal would receive), and selective reporting (publishing only some results).
• A small number of studies were rated unclear risk for random outcome assessment, blinding of outcome assessment, and incomplete outcome data. The remaining studies in these domains were rated low risk.

In plain language: the animal studies were generally acceptable but frequently lacked details that would let reviewers confirm the methods were free of bias.

Key Finding 1: AS-IV Blocks Cancer Cell Growth (Proliferation)

Rapid, uncontrolled proliferation (cell division and growth) is the hallmark of cancer. Blocking it can slow tumor progression and spread, which may lead to better outcomes for patients.

Almost all of the included studies demonstrated that AS-IV significantly inhibits the proliferation of HCC cells. Notably, the effect appears to be dose- and time-dependent — meaning higher concentrations and longer exposure produce stronger inhibition. This dose- and time-dependent relationship was reported across multiple studies.

There was one exception worth noting. The study by Pengfei Ma and colleagues found that treatment with 5–100 μg/mL of AS-IV for 24, 48, and 72 hours had no significant effect on the viability of MeCC97-e cells. The authors of this review suggest the reason may be that the concentration was simply too low. Notably, the same group's table entry lists a dose of 127 μM for 2 days, which did inhibit proliferation and invasion.

Several distinct molecular routes appear to be involved in AS-IV's anti-proliferative effect:

• The Nrf2-mediated TGF-β/Smad3 pathway. Three studies showed AS-IV inhibits HCC cell proliferation through this route. AS-IV also suppresses intracellular reactive oxygen species. Reactive oxygen species are unstable oxygen-containing molecules that can damage cells and drive cancer. AS-IV also regulates different phosphorylation forms of Smad3. Phosphorylation is a chemical "on/off switch" added to proteins.
• Succinylation of PGAM1. Succinylation is a common, dynamic post-translational modification (a chemical change made to a protein after it is built), occurring mostly inside mitochondria. It plays a critical regulatory role in tumor development. One recent study showed that AS-IV inhibits HCC cell proliferation and glycolysis (the way cancer cells rapidly burn sugar for energy) by regulating KAT2A-mediated succinylation of PGAM1.
• The NF-κB signaling pathway. Xiaocui An and colleagues found AS-IV inhibits HCC cell proliferation by modulating NF-κB signaling.
• Reducing anti-apoptotic proteins. AS-IV lowers the levels of proteins that normally protect cancer cells from dying, which also restrains their growth.

Key Finding 2: AS-IV Slows Spread and Invasion (Metastasis)

Metastasis (spread of cancer to other parts of the body) and invasion (cancer cells pushing into surrounding tissue) are the main reasons tumors become dangerous and prognosis worsens. A key driver is the abnormal reactivation of epithelial-mesenchymal transition (EMT) — a process where cells that normally stick together loosen up and gain the ability to move, like a transformation from a brick in a wall into a free-roaming cell.

Yaling Li and colleagues found that AS-IV significantly down-regulated the expression of lncRNA-ATB (a long non-coding RNA molecule that promotes tumor spread) in a dose- and time-dependent manner. This inactivated the IL-11/STAT3 signaling pathway, induced apoptosis of HCC cells, and reduced cell viability — ultimately inhibiting metastasis and invasion.

Chengdong Qin and colleagues showed that AS-IV treatment reduces the expression of EMT-related molecules by targeting the Akt/GSK-3β/β-catenin pathway. This weakened the invasive and migratory capabilities of HCC cells, with a clear dose-dependent relationship.

At various concentrations, AS-IV also inhibited EMT and thereby suppressed metastasis and invasion by reducing the levels of two proteins called N-cadherin and vimentin. Again, this effect was significantly dose-dependent.

Key Finding 3: AS-IV Triggers Programmed Cell Death (Apoptosis)

Apoptosis is an active, built-in form of programmed cell death — the body's normal way of removing damaged or unwanted cells. Cancer cells often evade apoptosis, which helps them survive and grow. Restoring apoptosis is therefore a major goal of cancer therapy.

Numerous studies support the idea that AS-IV stops HCC progression by promoting apoptosis:

• Through oxidative stress and NF-κB. Xiaocui An and colleagues found AS-IV promotes apoptosis in HCC cells by modulating oxidative stress and the NF-κB signaling pathway, with a concentration-dependent effect.
• Through cell-cycle arrest at G(1) phase. Chunmin Su and colleagues discovered AS-IV has cytotoxic (cell-killing) effects plus both exogenous and endogenous apoptotic effects on HCC cells. It triggered G(1) arrest — a halt in the phase of the cell cycle when cells prepare to copy their DNA — and reduced anti-apoptotic protein levels, allowing apoptosis to proceed.
• Through Caspase activation. Ting He and colleagues showed AS-IV enhances the expression of Caspase-3 and Caspase-9, two enzymes that carry out the cell-death program, promoting apoptosis and inhibiting HCC progression.
• Through miR-150-5p. Xiang Cui and colleagues found AS-IV induced upregulation of miR-150-5p, a small regulatory RNA molecule. This upregulation occurred both in vitro and in vivo. This suppressed β-catenin and increased the apoptosis rate of HCC cells.

Key Finding 4: AS-IV Helps the Immune System Fight the Tumor

Immunotherapy is a major focus of modern cancer treatment. A key molecule in this area is PD-L1 (programmed death ligand 1), which sits on the surface of cancer cells. When PD-L1 binds to PD-1 (programmed death-1) on immune cells, it acts like a "off switch" that helps the tumor escape immune attack — a process called immune evasion.

Yang Ma and colleagues found that AS-IV reduces PD-L1 levels on the cell surface through the miR-135b-5p/CNDP1 pathway. This relieves the PD-L1-related immune suppression (the immune-blocking effect) and thereby inhibits HCC progression.

Liang Min and colleagues showed a second immune-related mechanism. AS-IV suppressed M2 polarization of macrophages — the process by which immune scavenger cells are reprogrammed into a tumor-supporting state — via the TLR4/NF-κB/STAT3 signaling pathway. In their animal experiments, this significantly reduced tumor volume and body weight in the mice.

Key Finding 5: AS-IV Reverses Drug Resistance and Boosts Chemotherapy

Patients frequently develop resistance to chemotherapy after prolonged treatment. Their cancer cells stop responding to the drugs. This leads to chemotherapy failure and cancer recurrence.

Peipei Wang and colleagues studied Bel-7402/FU human HCC cells — a cell line engineered to be resistant to chemotherapy. They found that AS-IV reverses drug resistance by downregulating MDR1 (a protein pump that cancer cells use to expel chemotherapy drugs before they can work) through inhibition of the JNK/c-Jun/AP-1 pathway.

Xiaoyu Qu and colleagues found something similar with a different drug and a different protein. They showed AS-IV enhances chemosensitivity (how well cancer cells respond) to cisplatin — a standard chemotherapy drug — by suppressing MRP2, another drug-efflux protein. In their experiments, mice received 50 mg/kg of AS-IV for 14 days, while cells were treated with 0.4, 4, or 40 μM for 1 day.

Key Finding 6: AS-IV Blocks New Blood Vessel Growth (Angiogenesis)

Tumors need a blood supply to grow beyond a small size, so they trigger angiogenesis — the growth of new blood vessels. Cutting off that supply starves the tumor.

Shuo Zhang and colleagues conducted a purely in vivo study using an orthotopic tumor model. In this model, liver tumors are grown directly in the liver of BALB/c mice. This mimics human disease more closely than tumors grown under the skin. They gave 20 mg/kg of AS-IV for 21 days. The result: AS-IV inhibited HCC progression by suppressing angiogenesis.

Additional Mechanisms: Scar Tissue, Oxidative Stress, and Tumor Metabolism

Several studies revealed mechanisms that cross multiple categories.

Chong Zhang and colleagues used both liver cancer cells (HSC-T6 and HepG2) and mice with HCC induced by DEN/CCl4 (chemicals commonly used to create liver cancer in animals). Cell experiments used 5, 10, or 20 μM AS-IV for 1 day. Mice received 20, 40, or 80 mg/kg for 140 days. The finding: AS-IV inhibits HCC by regulating pSmad3C/3L and Nrf2/HO-1. This matters because liver fibrosis and cirrhosis — scarring of the liver — are major risk factors for HCC, and these pathways affect both scarring and oxidative stress.

Fanggong Yong and colleagues reported a closely related result in HepG2 cells (20 μM for 1 day). They also reported it in DEN/CCl4-induced C57BL/6J mice (40 mg/kg for 140 days). AS-IV inhibits HCC via Nrf2-mediated pSmad3C/3L transformation.

Yuanzhang Zhu and colleagues studied metabolism directly. Using SNU-182 and Huh7 cells (25 μM for 12 hours) and BALB/c mice with subcutaneous tumors (40 mg/kg for 28 days), they showed AS-IV inhibits HCC progression. AS-IV does this by regulating KAT2A-mediated succinylation of PGAM1. This targets the way cancer cells rewire their energy production — a hallmark of malignancy.

Finally, Lili Li and colleagues reported that AS-IV suppresses migration and invasion of HCC cells. AS-IV does this by regulating the Nrf2/HO-1 and TGF-β(1)/Smad3 pathways. They used Huh-7 cells at 5, 10, and 20 μM for 1 day.

What This Means for Patients

The review's overall conclusion is that AS-IV attacks HCC through multiple pathways at once. Specifically, the current evidence indicates AS-IV:

• Inhibits tumor cell proliferation (growth)
• Inhibits migration and invasion (spread)
• Induces apoptosis (programmed cell death)
• Modulates immune responses (helping the body fight the tumor)
• Reduces drug resistance while enhancing chemosensitivity (making chemotherapy work better)
• Suppresses angiogenesis (cutting off the tumor's blood supply)

This multi-target profile is relevant because HCC is a genetically complex cancer. A therapy that hits several weaknesses at once may be harder for the tumor to escape than a single-target drug. AS-IV also has a favorable safety profile in the preclinical work reviewed. That is why the authors describe AS-IV as a promising candidate. It is potentially a foundation for new HCC treatment strategies.

Importantly, though, this is preclinical research. The findings describe mechanisms — how the compound appears to work inside cells and animals — not proof that it helps patients. It also does not establish an effective or safe human dose. The concentrations used in the cell studies cannot simply be translated into a human regimen. The weight-based doses used in mice also cannot simply be translated into a human regimen. These doses ranged from 20 mg/kg to 150 mg/kg, with the longest treatment lasting 140 days.

Limitations: What This Review Could Not Prove

The authors are explicit about the gaps. The most important limitation is that no human clinical trials were included. All 16 studies were performed in cancer cell lines, in animals, or both. Findings in a petri dish or a mouse do not always hold true in people.

Second, the quality assessment revealed widespread uncertainty. In the in vitro studies, every study was rated unclear risk for blinding of outcome assessment, and several were unclear for allocation of study groups or accounting for confounding variables. In the animal studies, half were unclear on random sequence generation and random housing, and five studies each were unclear on baseline characteristics, allocation concealment, and selective reporting.

Third, the studies used a wide variety of designs. They differed in cell lines, animal models, doses, and treatment durations. That heterogeneity makes it difficult to compare results directly or to combine them into a single estimate of effect.

Fourth, one study (Pengfei Ma and colleagues) produced a negative result at low concentrations — no significant effect on cell viability at 5–100 μg/mL over 24–72 hours. This suggests that dose matters a great deal, and that not all findings point in the same direction.

Finally, the authors note that the precise therapeutic pathways of AS-IV in HCC remain incompletely elucidated. The picture is still being assembled.

Practical Recommendations

Based on this review, here is what patients and families should take away:

1. Do not use AS-IV or Astragalus supplements to treat liver cancer on your own. No human trial has yet shown that AS-IV helps patients with HCC. The evidence so far comes entirely from cells and animals.
2. Talk to your oncology team before starting any herbal product. Herbal supplements can interact with chemotherapy, targeted therapy, and immunotherapy drugs. Some can affect how quickly your body clears these medications.
3. Ask about clinical trials. The authors specifically call for large-scale, well-designed, multicenter randomized controlled trials before AS-IV can be broadly applied. If you are interested in this compound, ask whether any registered trial is recruiting.
4. Continue standard, proven treatments. The review's findings suggest AS-IV might one day work alongside chemotherapy — for example, by enhancing cisplatin sensitivity. But that idea has not been tested in patients, and AS-IV is not a substitute for surgery, ablation, radiation, targeted therapy, or immunotherapy.
5. Keep perspective on the strength of the evidence. These studies show "mechanisms" — plausible biological pathways. They explain how AS-IV might work. They do not show that it improves survival, shrinks tumors in people, or is safe at therapeutic doses in humans.

The authors conclude that the current evidence strongly highlights AS-IV's potential application value in HCC treatment. But they state clearly that robust clinical evidence is needed to solidify the foundation for its broader use. Until those trials are done, AS-IV remains a promising research lead, not an established therapy.

Frequently Asked Questions

What did the review find astragaloside IV does in laboratory and animal studies?

Across the 16 included studies, astragaloside IV blocked liver cancer cell growth. It slowed spread and invasion and triggered programmed cell death. It helped immune responses against tumors. It reduced drug resistance while boosting chemotherapy sensitivity. It also suppressed new blood vessel growth. These are mechanisms seen in cells and animals, not proven patient benefits.

Why does the review say human trials are still needed?

Findings in a petri dish or a mouse do not always hold true in people. The review also found widespread uncertainty in study methods, wide differences in cell lines, animal models, doses, and treatment durations, and one study with a negative result at low concentrations. The authors call for large randomized controlled trials before recommending it.

Could astragaloside IV interact with my chemotherapy or immunotherapy?

The review does not report human interaction data. It advises talking to your oncology team before starting any herbal product. Herbal supplements can interact with chemotherapy, targeted therapy, and immunotherapy drugs. Some can affect how quickly your body clears these medications. Do not take Astragalus or astragaloside IV without telling your team.

What doses of astragaloside IV were used in the reviewed studies?

Cell studies used concentrations from about 2.5 to 204 micromolar, and animal studies used weight-based doses from 20 mg/kg to 150 mg/kg, with the longest treatment lasting 140 days. The review states these cannot simply be translated into a human regimen, and no effective or safe human dose has been established.

Should I stop standard liver cancer treatment to try astragaloside IV?

No. The review says astragaloside IV is not a substitute for surgery, ablation, radiation, targeted therapy, or immunotherapy. Its findings suggest it might one day work alongside chemotherapy, for example by enhancing cisplatin sensitivity, but that idea has not been tested in patients. Continue standard, proven treatments and discuss any changes with your oncology team.

If I have hepatocellular carcinoma and want to try astragaloside IV or Astragalus, when should I get a second opinion?

No human trial has shown astragaloside IV helps patients with hepatocellular carcinoma. All 16 reviewed studies were done in cancer cells or animals. No safe or effective human dose is established. Before adding any herbal product, a second opinion can review whether it could interact with chemotherapy, targeted therapy, or immunotherapy, and whether a registered clinical trial is recruiting. It can also confirm that standard treatments such as surgery, ablation, radiation, targeted therapy, or immunotherapy remain the plan. Diagnostic Detectives Network provides independent expert second opinions.

Source Information

Original article title: Molecular mechanisms of astragaloside-IV in hepatocellular carcinoma therapy: a systematic review.

Authors: Xin Gao, Wen Hao, Yike Wang, Xiaqiu Wu, Feiye Zhu, and Yongsheng Zhang (corresponding author)

Author affiliations: School of Basic Medical Sciences, Zhejiang Chinese Medical University, Hangzhou, Zhejiang Province, China; Lanxi Hospital of Traditional Chinese Medicine, Jinhua, China; and School of Public Health, Zhejiang Chinese Medical University, Hangzhou, China

Publication: BMC Cancer, 2025, volume 25, article 1407

DOI: https://doi.org/10.1186/s12885-025-14758-w

Article type: Systematic review (open access, published under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License)

Number of studies analyzed: 16 (from 181 identified records)

Search period: From database inception through March 2025, across PubMed, Cochrane, EMBASE, CNKI, and Wanfang Data

This patient-friendly article is based on peer-reviewed research. It summarizes a systematic review of laboratory and animal studies only. No human clinical trials of astragaloside IV in hepatocellular carcinoma were identified in this review, and nothing here should be taken as a recommendation to use astragaloside IV or any herbal supplement to treat cancer. Always discuss treatment decisions with a qualified oncology team.