NOTCH1 and neoplasm: In addition, Bax was upregulated and the survivin gene was downregulated compared to cells treated with silibinin or transfected with Notch1 siRNA.111 Chang et al treated line 786-O renal carcinoma with silibinin, and their results showed that urokinase plasminogen activator (u-PA), metalloproteinase (MMP) -2, -9 and MAPK pathway protein expression decreased and tumor weight was reduced.112 Studies on human ovarian cancer cells showed that silibinin inhibits ERK and Akt and reduces tumor growth.113 Non-small cell lung cancer was treated with silibinin.