Multi-dimensional insights into Brucea javanica (L.) Merr. in cancer treatment: current status, challenges and future directions.

BACKGROUND: Brucea javanica (L.) Merr. (B. javanica) is a medicinal plant with a long history of clinical application and proven antitumor activity. Its oil emulsion (BJOE) is widely used as a cancer adjuvant therapy. However, a comprehensive understanding of its chemical composition, multi-component synergistic mechanism, key antitumor signaling pathways, formulation optimization challenges, clinical translation bottlenecks, and safety issues remain insufficient, which greatly limits its rational development and precise clinical application. PURPOSE: This review aims to systematically summarize the chemical composition, pharmacological mechanism, antitumor properties, formulation progress, clinical efficacy and safety of B. javanica, and critically point out the current research gaps and key challenges in basic and applied research. STUDY DESIGN AND METHODS: Keywords related to B. javanica, quassinoids, structure-activity relationships, pharmacology, formulations, and clinical aspects to include published studies from 2008-2025 were searched in the following databases: SciFinder, Web of Science, PubMed, China National Knowledge Infrastructure (CNKI) and Wanfang database. Relevant literature in both Chinese and English obtained from the above search was incorporated into this review. RESULTS: Over 100 quassinoids, 48 triterpenoids, and 27 alkaloids have been identified from B. javanica. As the core antitumor components, quassinoids exert pharmacological activities through the regulation of PI3K/AKT, MAPK, NF-κB and various other vital signaling cascades. Targeted nano-formulations can enhance tumor accumulation, but large-scale production is difficult and stability is insufficient. Clinically, BJOE can improve the efficacy of chemo-radiotherapy, but carries risks of allergic reactions and multi-system injury. CONCLUSION: This review clarifies the key antitumor components, signaling pathways, delivery strategies and safety profiles of B. javanica. Despite its significant antitumor potential, instability in quality, unclear synergistic mechanisms, unstable delivery systems, and safety issues remain major challenges. This study provides comprehensive evidence base and identifies key research gaps to support the further rational development of therapies based on B. javanica.