Breast cancer is a malignancy, chiefly affecting women, caused by uncontrolled growing of breast cells, and can metastasize. Breast cancer is frequently linked to hepatic complications, which may be brought on by the tumor's metastatic progression to the liver or precipitated by the systemic usage of anti-breast cancer chemotherapeutic drugs. There are several clinical and pathological manifestations of liver metastases of breast cancers which are fatal. Briefly, when breast cancer cells reach the liver, they can disrupt typical liver functions precipitating hepatotoxicity. Impairments in hepatic functions may also be found in non-metastatic breast cancers. The reasons why breast cancer can occasionally manifest as a disease that is liver dominant or that involves the liver disorders mainly as a late event in the course of the disease are not still well understood[1-4].

Although there are a number of available systemic therapeutic regimens, the adjunct therapies, remains the cornerstone of treatment for hepatic metastases. Despite these therapies, liver metastasis from breast cancer is associated with a poor prognosis. Certain anti-breast cancer chemotherapeutic medications like methotrexate, tamoxifen, doxorubicin,anastrozole, letrozole, ribociclib, trastuzumab etc., or pre-existing liver conditions also may aggravate hepatic complications in breast cancers. In order to lower their occurrence and enhance outcomes when they do occur, it is hoped that continued study into the processes and tropism of liver metastasis from breast cancer will lead to more targeted therapeutics[3, 5]. On the other hand, search of alternative/adjunct therapies would circumvent the problems with minimal negative effects. The medicinal plants, in this connection, historically can play a leading role.

Several studies in phytopharmacology have demonstrated that, the medicinal plants can have anti-hepatotoxic and anti-cancer effects on breast cancers. In order to find viable treatments for preventing the invasion and spread of breast cancer cells to the liver and to alleviate the chemotherapy-induced liver toxicity, this review article looks at scientific research on medicinal plants that have both hepatoprotective and anti-breast cancer properties. This review attempts to shed light on the concomitant potential of medicinal plants in this context by exploring and summarizing the published literature on medicinal plants. The objective of the present narrative review is to gather the primary knowledge to facilitate the development of dual-acting therapies against liver damage related to breast cancer.

Inclusion criteria

An internet-based scrutiny of scientific literature was conducted by probing through an array of online bibliographic databases, including Google, Scholar Google, PubMed, Toxnet, Wiley, Web of Science, EMBASE and Science Direct; by using key words and phrases such as ‘medicinal plants’ (their common or botanical names) against ‘breast cancer’ ‘mammary carcinoma’ and ‘liver toxicity’, ‘liver diseases (hepatic cirrhosis, fibrosis, stasis, injury, damage)’, ‘hepato-toxicity’ or ‘hepatoprotective’, ‘antihepatotoxic’ in feasible combinations. This endeavour involved searching the full-text scientific research articles published online in peer-reviewed scientific journals during the last 25 years (2000 – 2025). The preclinical and clinical research on higher plants that were both effective against breast cancers and liver toxicity/diseases in animal system/tissues and were published in English was selected.

Exclusion criteria

The articles that were taken into consideration were those written exclusively in English. Articles that were not subjected to peer review but were hosted on particular web portals as pre-prints were excluded. Published but later retracted articles were also rejected. Grey literature was not considered. Current collation and discourse do not cover the use of medicinal plant combinations, used with other agents or tested in plant systems.

The present study collates the scientific literature on medicinal plants that have concomitant hepatoprotective and anti-breast cancer effects. It was found that, 66 (sixty six) medicinal plant extracts, demonstrated preclinical evidence of effectiveness against both breast cancers and liver complications, based on the foregoing criteria. The exercise is summarised in [Fig. 1]. [Table. 1] enumerates all of the information succinctly[6-202]. Newer such reports may continually appear in the scientific literature. Most of them are well-recognized traditional dietary/medicinal plants with several traditional and contemporary medicinal usage. 

Breast cancer is one of the major malignancy increasingly affecting woman’s health worldwide[203]. Human breast cancer MCF-7 cells were the most commonly used breast cancer model followed by MDA-MB-231 cells. Drugs (paracetamol, rifampin, bleomycin, doxorubicin etc.), chemicals (carbon tetrachloride, ethanol, thioacetamice etc.) and heavy metals (lead, cadmium, arsenic etc.) induced hepatic disorders, principally induced in rodents were the experimentally invoked liver complications used for the hepatoprotective assessments. Generally estimated physiological parameters were cytotoxicity, cell proliferation, cell viability, mitotoxicity, apoptosis and genotoxicity in the cases of anti-breast cancer evaluations. On the other hand, haematological and liver function parameters along with lipid profile, antioxidant and anti-inflammatory biomarker parameters were evaluated to measure hepatic protection property of the same plants. In the majority of such cases, histopathological analyses of liver tissues were also carried out for corroboration. Preservation of liver structure, modulation of hepatic functions and oxidative stress-inflammatory pathways were the principal mechanisms of antihepatotoxic effect. These are the preclinical studies.

The observed pre-clinical anti-breast cancer mechanisms included: cytotoxic, anti-proliferative, antitumor, apoptopic, estrogenic, anti-genotoxic, anti-angiogenesis, antimetastatic, antimitotic/cell cycle arrest, autophagy, antioxidant, anti-carcinogenic/chemopreventive etc.; whereas, the pre-clinical hepatoprotective mechanisms deduced are: cytoprotective/antihepatotoxic, antioxidative, anti-inflammatory, apoptopic, anti-fibrotic, anti-hyperlipedemic/hypolipedimic, detoxifying, free radical scavenging etc. by modulating multiple pathophysiological processes/pathways pertaining to both the breast cancer and liver structure/functions.

Only one clinical study involving 30 patients with non-metastatic breast cancer participated in a randomized, triple-blind, placebo-controlled study evaluated the preventive benefits of oral treatment of standardized seed extract (silymarin) from milk thistle plant (Silybum marianum), against the liver injury brought on by its breast cancer chemotherapy -doxorubicin/cyclophosphamide-paclitaxel treatment regime[204]. It is pertinent to mention here that, Silybum marianum (milk thistle) seed has already been reported to possess both hepatoprotective and anti-breast cancer effects at the pre-clinical stages [Table. 1]. 

Hepatotoxicity is a common yet serious recognized complication of the extant cancer chemotherapy. As mentioned in the introduction section, anti-breast cancer medications pose noxious effects to the liver health. Moreover, breast cancer while metastasis, affects liver or there may be pre-existing hepatic diseases which may aggravate during cancer. Hence, in the several ways, the liver, the cardinal mammalian organ of metabolism and detoxification, becomes quite vulnerable towards serious damage in breast cancer; leading to gross physiological deterioration of a breast cancer patient. Medications, in novel/alternative ways, should therefore be devised to counteract both neoplasm and hepatic damage in breast cancer patients with less adverse effects. 

The dietary and medicinal plants are known to serve as a classical source of extant antineoplastic drugs and hepatoprotective medications, in particular for the later purpose, in these days also[197, 205]. The pleiotropic 

pharmacological effect that enables medicinal plants and their constituents to act through multiple stages and pathways is well recognized[206, 207]. The present study reveals the medicinal plants have the concomitant potentiality to counteract breast cancer as well as hepatotoxicity. Newer site/target-specific targeted drug delivery systems like nanotechnology can improve the pharmacokinetic and pharmacodynamic efficacy of putative phytochemicals[208]. Nevertheless, one should be more cautious in extrapolating these preclinical findings to clinical set up, as the foregoing studies suffer from certain gross limitations which are summarized in the next section.

Having being a narrative review, the current work has explicit limitations. Except one, the research studies selected are pre-clinical studies that are stand-alone in nature, often in different experimental models and different plant parts/extracts, performed with uncharecterized/partially charecterized crude plant extracts/fractions. Some issues need to be addressed. How can a single plant extract be both "cytotoxic" (against cancer cells) and "cytoprotective" (to hepatocytes)? What are the active phytoconstituents responsible for dual activity in same model? Are the anti-cancer and hepatoprotective doses compatible? Are there any conflicting findings? Further definitive studies are necessary to unveil the phytochemistry, shared pathways, molecular targets with deeper analysis of mechanisms, drug-herb interactions or synergistic mechanisms and bioavailability and toxicological issues with dose-response relationships that could provide novel scientific insights for their molecular basis of dual action in the same model in pre-clinical stage, for possible clinical translation.

To the best of the present author’s knowledge, this is the first report of this kind. The specific dual properties of cytotoxicity (against breast cancer) and cytoprotection (in case of liver damage) with mechanisms thereof should be much explored further in order to develop an effective dual-acting plant-derived natural therapeutics against hepatic 

damage associated with breast cancers by arresting pathogenesis of both the disorders with less toxicity. More definitely designed mechanistic pre-clinical studies and clinical studies could be the way ahead to circumvent the limitations and explore their concrete translational potential. Both pre-clinically and clinically ratified phytoconstituent like silymarin from milk thistle plant may be a right druggable candidate here. The present preliminary synoptic report is a first-time of such compilation which may serve as a primary database for understanding and benefitting future researchers in this progressive field aiding to combat cancer, protecting the vital organs.