To use or not to use, that is the question

Whether or not to use antioxidants in cancer patients receiving chemotherapy has continued to be a hot topic in health care professionals working in the arena of both alternative medicine and western medicine. Use of antioxidants is discussed in recent research findings related to antioxidant use before and after surgery, before,during, and after chemotherapy, and radiation therapy.

Review of research (2018)

Before we begin, we should point out that ‘chemotherapy reduces serum levels of antioxidant vitamins and minerals due to lipid peroxidation and thus produces higher level of oxidative stress'(Singh et al., 2018, p. 180). A recent review of research conducted by Singh et al. found 3 themes in their review of the literature. First, antioxidants reduce the severity of chemotherapy toxic side effects (2018).  Second, in opposing oxidative stress apoptosis it was found that excessive oxidative stress blocks caspase activity and drug-induced apoptosis, in essence means that the chemotherapy agents cannot effectively do their job by killing cancer cells(Singh et al., 2018). Indeed there is a fragile ‘balance exists between antioxidant repairing systems and pro-oxidant mechanism of tissue destruction, which if tipped in favour of cellular damage, could lead to significant tissue mutilation'(Singh et al., 2018, p. 179).

So if the reactive species are at fault for the toxic side effects of chemotherapy then it is only fair to conclude that antioxidants will reduce the severity of side effects with no affect on the chemotherapy medications efficacy(Singh et al., 2018). Lastly, the third view points to evidence that cancer cells will become more vulnerable to chemotherapy agents if antioxidant therapy is used as treatment. This is believed to occur because cancer cells cannot use antioxidants to repair damage(Singh et al., 2018). It is important to point out Singh et al., found that evidence supporting the notion that antioxidant administration during chemotherapy reduces the risk of reducing tumor control was lacking, opposed to evidential strength on numerous well designed studies found supporting the use of antioxidants during chemotherapy for numerous health benefit reasons (2018).

Not all antioxidants are appropriate for all cancers. It is highly individualized, and administration should not be undertaken without a medical and nutritional professionals guidance.  Research continues regarding the use of antioxidants in chemotherapy. One recent research study conducted by Li et al., found in mice that ‘precancerous lesions need the antioxidant effect of glutathione to progress to breast cancer, but ‘… ‘On the other hand, in breast cancer, antioxidant treatment decreased DNA lesions and tumorigenesis in a murine model of BRCA1-deficient, breast cancer ‘(Sarmiento-Salinas et al., 2019, p. 11).  Chico and Tuveson (2017),  performed work on metastatic cancer and found that: late-stage cancer’s incurability may be due to its possession of too many antioxidants'(Asadi-Samani et al., 2019, p. 4). Watson (2013) believes we must concretely ask the question, Do antioxidants cause or prevent cancer?A lot of thought and discussion should occur before starting the use of antioxidants in this group of patients.  As all antioxidants are not treated equal neither should all cancers.

The use of antioxidants in radiation therapy also should be individualized. Although there has been recent research that has shown in nasopharyngeal carcinoma the ‘antioxidants (b-Carotene, NAC, GSH) played an antiapoptotic role in response to radiation via decreasing ROS production and inhibiting MAPK pathway’ promoting tumor growth and decreasing the efficacy of radiation therapy(Meng et al., 2020, p. 770) there are other studies that promote their use. In breast cancer it was found that the more advanced disease the lower serum levels of antioxidants and that retinol, beta-carotene, and zinc when given together have a synergistic affect and promote apoptosis and reduce proliferation of cancer cells(Rosa et al., 2019).

Agree or Disagree

I neither agree nor disagree. I think antioxidants should be utilized with caution and that appropriate guidance by healthcare professionals should be undertaken by a cancer patient who needs to undergo radiotherapy and is considering use of these supplements. I only agree with their use if there has been adequate research and strong evidence supporting their benefit. This should be individualized and tapered to fit the cancer and treatment.

References

1. Asadi-Samani, M., Farkhad, N. K., Mahmoudian-Sani, M. R., & Shirzad, H. (2019). Antioxidants as a Double-Edged Sword in the Treatment of Cancer. Antioxidants, 1–12. https://doi.org/10.5772/intechopen.85468
2. Chio II, C.-4., & Tuveson, D. A. (2017). ROS in cancer: The burning question. Trends in Molecular Medicine, 23(5), 411–429. https://doi.org/10.1016/j.molmed.2017.03.004
3. Li, M., Chen, Q., & Yu, X. (2017). Chemopreventive effects of ROS targeting in a murine model of BRCA1-deficient breast cancer. Cancer Research, 27, 448– 458. https://doi.org/10.1158/0008-5472.CAN-16-2350
4. Meng, D.-F., Guo, L.-L., Peng, L.-X., Zheng, L.-S., Xie, P., Mei, Y., Li, C.-Z., Peng, X.-S., Lang, Y.-H., Liu, Z.-J., Wang, M.-D., Xie, D.-H., Shu, D.-T., Hu, H., Lin, .-T., Li, H.-F., Luo, F.-F., Sun, R., Huang, B.-J., & Qian, C.-N. (2020). Antioxidants suppress radiation-induced apoptosis via inhibiting MAPK pathway in nasopharyngeal carcinoma cells. Biochemical and Biophysical Research Communications, (537), 770–777. https://doi.org/10.1016/j.bbrc.2020.04.093
5. Rosa, C., Franca, C., Vieira, S. L., Carvalho, A., Penna, A., Nogueira, C., Lessa, S., & Ramalho, A. (2019). Reduction of serum concentrations and synergy between Retinol, -Carotene, and Zinc according to cancer staging and different treatment modalities prior to radiation therapy in women with breast cancer. Nutrients, 11(2953), 1–8. https://doi.org/10.3390/nu11122953
6. Sarmiento-Salinas, F. L., Delgado-Magallón, A., Montes-Alvarado, J. B., Ramírez-Ramírez, D., Flores-Alonso, J. C., Cortés-Hernández, P., Reyes-Leyva, J., Herrera-Camacho, I., Anaya-Ruiz, M., Pelayo, R., Millán-Pérez-Peña, L., & Maycotte, P. (2019). Breast cancer subtypes present a differential production of reactive oxygen species (ROS) and susceptibility to antioxidant treatment. Frontiers in Oncology, 9(480), 1–13. https://doi.org/10.3389/fonc.2019.00480
7. Singh, K., Bhori, M., Kasu, Y. A., Bhat, G., & Marar, T. (2018). Antioxidants as precision weapons in war against cancer chemotherapy induced toxicity – Exploring the armoury of obscurity. Saudi Pharmaceutical Journal, 26, 177–190. https://doi.org/10.1016/j.jsps.2017.12.013
8. Watson, J. (2013). Oxidants, antioxidants and the current incurability of metastatic cancers. Open Biology, 3(1), 120144. https://doi.org/10.1098/rsob.120144