Ayurvedic Management Of Metastatic Small Cell Neuroendocrine Carcinoma Using Rasaushadhi: A Case Report

Abstract

Background: Metastatic small cell neuroendocrine carcinoma (SCNC) is an aggressive malignancy with limited treatment options and poor prognosis under conventional therapies. Ayurvedic medicine may offer a complementary and integrative approach utilizing classical metal mineral-based formulations (Rasa Shastra) that may offer anti-neoplastic activity with acceptable tolerability. Case Presentation: A 58-year-old male with confirmed metastatic small cell neuroendocrine carcinoma presented with bilateral cervical lymphadenopathy, mediastinal nodal involvement, bilateral pulmonary nodules, and multiple skeletal metastases. The primary tumour was identified at the lower lobe of the right lung on whole body PET-CT (May 2022). The patient received single siting of platinum-based combination chemotherapy, which included Inj. Carboplatin (200 mg), Inj. Etoposide (100 mg) as cytotoxic agents and Inj. Zoledronic acid (4 mg) as supportive therapy. After Chemotherapy, patient was given Ayurvedic drugs containing Naga Bhasma (62.5 mg), Rasasindura (62.5 mg), and Guduchi Satva (125 mg) once daily (OD) for two cycles of 30 days each with a one-week interval between cycles. Outcome: Follow-up whole body PET-CT (January 2023) demonstrated complete metabolic regression in the cervical region, regression in size and FDG uptake of mediastinal lymph nodes, regression of the known primary site, and stabilization of skeletal metastases. No new metabolically active lesions were identified. Safety: Serial laboratory monitoring documented chemotherapy-induced anaemia (resolved by January 2023), transient leukocytosis, and elevation of blood lead levels to 71.5 µg/dL in December 2022 (baseline 3.3 µg/dL). Critically, no classical clinical signs of lead toxicity were observed including the absence of Burton's line on gingival examination. Naga Bhasma was withheld, and Ayurvedic antidote therapy with Ghrutkumari (Aloe vera) + Haridra (Turmeric) was initiated. Conclusion: This case report shows the tumour regression in small cell neuroendocrine carcinoma with an integrative approach of chemotherapy along with Ayurvedic formulation. However, the documented lead elevation mandates strict quality control, mandatory baseline and monthly heavy metal screening, and renal monitoring as non-negotiable prerequisites for the safe use of Naga Bhasma in clinical practice.