Journal of the National Cancer Institute Advance Access originally published online on September 9, 2008
JNCI Journal of the National Cancer Institute 2008 100(18):1334-1335; doi:10.1093/jnci/djn280
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Published by Oxford University Press 2008.
CORRESPONDENCE |
Response: Re: Should Supplemental Antioxidant Administration Be Avoided During Chemotherapy and Radiation Therapy?
Affiliations of authors: Uniformed Services University of the Health Sciences, Bethesda, MD (BDL); Department of Radiation Oncology, Indiana University School of Medicine, Indianapolis, IN (BDL); Radiation Oncology Division and Breast Health Center, Naval Medical Center San Diego, San Diego, CA (BDL); Friedman School of Nutrition Science and Policy and Antioxidants Research Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA (JBB)
Correspondence to: Brian D. Lawenda MD, MC USN, Radiation Oncology and Breast Health Center, Naval Medical Center San Diego, San Diego, CA (e-mail: brian.lawenda{at}med.navy.mil).
We appreciate the comments from Pathak and Bhutani and share their perspective, as noted in our Commentary (1), that an adjunctive role for dietary antioxidant supplements holds substantial promise for clinical application in oncology. However, we feel that therapeutic guidelines for using dietary antioxidant supplements in current practice must be based on the recognition of their potential benefits and risks. The evidence on complementary antioxidant treatments is inadequate and equivocal with regard to benefits, and the most robust studies available indicate a likelihood of harm (2,3). Because most of the studies that suggest the safety of antioxidant supplements were inadequately designed or underpowered to detect a detrimental effect on tumor control or survival, we concluded with our advice to physicians: primum non nocere. Nonetheless, work by Pathak and Bhutani (4,5) and others, including our own investigations (6), has demonstrated the critical need to expand both basic and clinical investigations in this area. Indeed, these studies should directly inform the design and conduct of new trials in cancer patients. This new work needs to focus on the complex interactions between antioxidants and radiation and/or chemotherapy, including their individual and combined molecular mechanisms of action. However, until we can better define the efficacy and safety of these combination treatments, we should advise our patients to avoid high-dose antioxidant supplements during cytotoxic therapies for cancer.
NOTES
The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, Department of Agriculture, or the United States Government.
REFERENCES
1. Lawenda B, Kelly K, Ladas E, Sagar S, Vickers A, Blumberg J. Should supplemental antioxidant administration be avoided during chemotherapy and radition therapy? J Natl Cancer Ins. (2008) 100(11):773–783.
2. Bairati I, Meyer F, Gelinas M, et al. Randomized trial of antioxidant vitamins to prevent acute adverse effects of radiation therapy in head and neck cancer patients [see comment]. J Clin Oncolog. (2005) 23(24):5805–5813.[CrossRef]
3. Bairati I, Meyer F, Jobin E, et al. Antioxidant vitamins supplementation and mortality: a randomized trial in head and neck cancer patients. Int J Cancer. (2006) 119(9):2221–2224.[CrossRef][Web of Science][Medline]
4. Pathak AK, Bhutani M, Guleria R, et al. Chemotherapy alone vs. chemotherapy plus high dose multiple antioxidants in patients with advanced non small cell lung cancer. J Am Coll Nutr. (2005) 24(1):16–21.
5. Pathak AK, Singh N, Khanna N, Reddy VG, Prasad KN, Kochupillai V. Potentiation of the effect of paclitaxel and carboplatin by antioxidant mixture on human lung cancer h520 cells. J Am Coll Nutr. (2002) 21(5):416–421.
6. Lawenda BD, Smith DE, Xu L, et al. Do the dietary supplements epigallocatechin gallate or vitamin E cause a radiomodifying response on tumors in vivo? A pilot study with murine breast carcinoma. J Soc Integr Oncol. (2007) 5(1):11–17.[CrossRef][Medline]
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J Natl Cancer Inst 2008 100: 1334.
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