Abstract: Anticancer chemotherapy with cyclophosphamide (CTX) is accompanied by toxic side effects such as bone marrow suppression and intestinal mucosal injury, which seriously affects the treatment tolerance and prognosis of patients. In recent years, polysaccharides have been used as detoxifying and synergistic adjuncts for antitumor drugs due to their anticancer, anti-inflammatory, and immunoregulatory activities. This paper systematically summarizes polysaccharide purification technologies, elaborates on the detoxification mechanism of polysaccharides on CTX from multiple perspectives such as immunomodulation, antioxidation, intestinal protection, liver and kidney protection, and reproductive system protection, and discusses the synergistic effect of polysaccharides with CTX by directly or indirectly killing tumors. Furthermore, the regulatory pathways of polysaccharides in cancer chemotherapy are summarized from two aspects: toxicity reduction and efficacy enhancement. We hope that this review could provide a reference for research on the mechanism of action of polysaccharides in reducing the toxicity and enhancing the efficacy of CTX, and provide new directions for reducing the toxic side effects of CTX.

Key words: polysaccharides; cyclophosphamide; extraction and purification; toxicity reduction; synergistic effect