Durian and Sapodilla Extracts Enhance Chemotherapy Sensitivity and Promote Apoptosis in Triple Negative Breast Cancer Model in Vitro: Systematic Review

Background: Triple-negative breast cancer (TNBC) is an aggressive subtype of breast cancer with main option for therapeutic is chemotherapy. Natural compounds, such as durian (Durio zibethinus) and sapodilla (Manilkara zapota) extracts, have demonstrated anticancer properties, including apoptosis induction and the potential to overcome chemotherapy resistance. Objective: This systematic review evaluates the effects of these extracts on TNBC cells, focusing on their ability to enhance chemotherapy sensitivity with induced apoptosis and decreased chemotherapy resistance. Methods: A systematic review was conducted in accordance with PRISMA guidelines. Literature searches in PubMed, Scopus, Web of Science, and Google Scholar identified studies investigating the effects of durian and sapodilla extracts on breast cancer. Data extraction focused on study design, cell lines, preparation and concentrations of extracts, and outcomes such as apoptosis, chemotherapy sensitivity, and molecular marker expression. Results: Included studies demonstrated that durian and sapodilla extracts significantly enhanced the efficacy of chemotherapy agents such as paclitaxel and doxorubicin. Both extracts contained bioactive that reduced Fas, Caspase-3, Caspase-9, and XIAP expression. The combination treatments were shown to synergistically enhance chemotherapy-induced cytotoxicity while reducing resistance mechanisms. Conclusion: Bioactive compounds in durian and sapodilla extracts target multiple pathways involved in TNBC apoptosis, progression and chemotherapy resistance. These findings suggest their potential as natural adjuvants to enhance chemotherapy efficacy. Further studies are needed to validate these results in vivo and explore their clinical applicability.