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Komplementärer Einsatz von Antioxidanzien und Mikronährstoffen in der Onkologie

Update 2013

Complementary use of antioxidants and micronutrients in oncology

Update 2013

  • Leitthema
  • Published:
Der Onkologe Aims and scope

Zusammenfassung

Hintergrund

Je nach Tumorentität und Geschlecht supplementieren bis zu 90% der onkologischen Patienten ihre Therapie mit antioxidativen und immunstabilisierenden Mikronährstoffen, häufig ohne das Wissen des behandelnden Arztes.

Methoden

Anhand der publizierten wissenschaftlichen Daten und anderweitigen verfügbaren Informationen, z. B. Homepages, ESPEN-Guidelines, wurden Alternativen zur Schulmedizin beurteilt.

Ergebnisse

Obwohl berechtigte Bedenken von onkologischer Seite bestehen, dass Nahrungsergänzungsmittel die Effektivität der Chemo- oder Strahlentherapie beeinträchtigen könnten, geben aktuelle Studien zunehmend Hinweise darauf, dass die medikationsorientierte Supplementierung von Antioxidanzien und anderen Mikronährstoffen wie Selen, L-Carnitin und Vitamin D das Ansprechen auf die antineoplastischen Verfahren (CT, RT) durch eine bessere Compliance, eine verringerte Rate an Nebenwirkungen und somit auch an Therapieabbrüchen steigern, sondern auch die Lebensqualität und die Prognose der onkologischen Patienten verbessern kann.

Schlussfolgerung

Onkologisch tätige Ärzte sollten über die Bedeutung von Selen und anderen Mikronährstoffen sowie potenziellen Interaktionen mit der Krebstherapie informiert sein.

Abstract

Context

Many patients being treated for cancer use micronutrient supplements with the intention to complement the cancer treatment or help them cope with the therapy and disease-associated side-effects. Up to 90 % of cancer patients supplement with antioxidants without the knowledge of the treating physician.

Methods

Alternatives to textbook medicine were assessed from published scientific data and otherwise available information, e.g. homepages, ESPEN-Guidelines.

Results

There are many concerns that antioxidants might decrease the effectiveness of chemotherapy but increasing evidence suggests a benefit when antioxidants and other micronutrients, such as selenium, L-carnitine and vitamin D are added to conventional cytotoxic therapies.

Conclusion

However, it is imperative that physicians explore the use of antioxidant and other micronutrient supplements with cancer patients and educate them about potentially negative and also potentially beneficial effects.

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Literatur

  1. Micke O, Bruns F, Glatzel M et al (2009) Predictive factors for the use of complementary and alternative medicine (CAM) in radiation oncology. Eur J Integr Med 1:22–30

    Google Scholar 

  2. Holzhauer P, Gröber U (2010) Checkliste: Komplementäre Onkologie. Hippokrates, Stuttgart

  3. Gröber U, Hübner J, Holzhauer P et al (2010) Antioxidanzien und andere Mikronährstoffe in der komplementären Onkologie. Onkologe 16:73–79

    Article  Google Scholar 

  4. D’Andrea G (2005) Use of antioxidants during chemotherapy and radiotherapy should be avoided. CA Cancer J Clin 55(5):319–321

    Article  Google Scholar 

  5. Block KI, Koch AC, Mead MN et al (2007) Impact of antioxidant supplementation on chemotherapeutic efficacy: A systematic review of the evidence from randomized controlled trials. Cancer Treat Rev 33:407–418

    Article  PubMed  CAS  Google Scholar 

  6. Block KI, Koch AC, Mead MN et al (2008) Impact of antioxidant supplementation on chemotherapeutic toxicity: a systematic review of the evidence from randomized controlled trials. Int J Cancer 123:1227–1239

    Article  PubMed  CAS  Google Scholar 

  7. Mücke R, Schomburg L, Büntzel J et al (2010) Komplementärer Seleneinsatz in der Onkologie. Onkologe 16:181–186

    Article  Google Scholar 

  8. Gröber U (2012) Arzneimittel und Mikronährstoffe. 2. Aufl. Wissenschaftliche Verlagsgesellschaft, Stuttgart

  9. Bozzetti F (SCRINIO Working Group) (2009) Screening the nutritional status in oncology: a preliminary report on 1,000 outpatients. Support Care Cancer 17(3):279–284

    Article  PubMed  Google Scholar 

  10. Tong H, Isenring E, Yates P (2009) The prevalence of nutrition impact symptoms and their relationship to quality of life and clinical outcomes in medical oncology patients. Support Care Cancer 17(1):83–90

    Article  PubMed  CAS  Google Scholar 

  11. Fearon KC, Voss AC, Hustend DS (2006) Definition of cancer cachexia: effect of weight loss, reduced food intake and systemic inflammation on functional status and prognosis. Am J Clin Nutr 83(6):1345–1350

    PubMed  CAS  Google Scholar 

  12. Churilla TM, Brereton HD, Klem M et al (2012) Vitamin D deficiency is widespread in cancer patients and correlates with advanced stage disease: a community oncology experience. Nutr Cancer (Epub ahead of print)

  13. Fakih MG, Trump DL, Johnson CS et al (2009) Chemotherapy is linked to severe vitamin D deficiency in patients with colorectal cancer. Int J Colorectal Dis 24(2):219–224

    Article  PubMed  Google Scholar 

  14. Crew KD, Shane E, Cremers S et al (2009) High prevalence of vitamin D deficiency despite supplementation in premenopausal women with breast cancer undergoing adjuvant chemotherapy. J Clin Oncol 27(13):2151–2156

    Article  PubMed  CAS  Google Scholar 

  15. Trump DL, Chadha MK, Sunga AY et al (2009) Vitamin D deficiency and insufficiency among patients with prostate cancer. BJU Int 104(9):909–914

    Article  PubMed  CAS  Google Scholar 

  16. Skrzydlewska E, Sulkowski S, Koda M et al (2005) Lipid peroxidation and antioxidant status in colorectal cancer. World J Gastroenterol 11(3):403–406

    PubMed  CAS  Google Scholar 

  17. Leung EY, Crozier JE, Talwar D et al (2008) Vitamin antioxidants, lipid peroxidation, tumour stage, the systemic inflammatory response and survival in patients with colorectal cancer. Int J Cancer 123(10):2460–2468

    Article  PubMed  CAS  Google Scholar 

  18. Look MP, Musch E (1994) Lipid peroxides in the polychemotherapy of cancer patients. Chemotherapy 40(1):8–15

    Article  PubMed  CAS  Google Scholar 

  19. Stefanini M (1999) Cutaneous bleeding related to zinc deficiency in two cases of advanced cancer. Cancer 86(5):866–870

    Article  PubMed  CAS  Google Scholar 

  20. Büntzel J, Bruns F, Glatzel M et al (2007) Zinc concentrations in serum during head and neck cancer progression. Anticancer Res 27:1941–1943

    PubMed  Google Scholar 

  21. Gröber U (2009) Antioxidants and other micronutrients in complementary oncology. Breast Care 4(1):13–20

    Article  PubMed  Google Scholar 

  22. Arends J, Bodoky G, Bozzetti F et al (2006) ESPEN Guidelines on enteral nutrition: non-surgical oncology. Clin Nutr 25(2):245–259

    Article  PubMed  CAS  Google Scholar 

  23. Grant WB, Cross HS, Garland CF et al (2009) Estimated benefit of increased vitamin D status in reducing the economic burden of disease in western Europe. Prog Biophys Mol Biol 99(2–3):104–113

    Google Scholar 

  24. Churilla TM, Brereton HD, Klem M et al (2012) Vitamin D deficiency is widespread in cancer patients and correlates with advanced stage disease: a community oncology experience. Nutr Cancer (Epub ahead of print)

  25. Abbas S, Linseisen J, Slanger T et al (2008) Serum 25-hydroxyvitamin D and risk of post-menopausal breast cancer–results of a large case-control study. Carcinogenesis 29(1):93–99

    Article  PubMed  CAS  Google Scholar 

  26. Drake MT, Maurer MJ, Link BK et al (2010) Vitamin D insufficiency and prognosis in non-Hodgkin’s lymphoma. J Clin Oncol 28(27):4191–4198

    Article  PubMed  Google Scholar 

  27. Gorham ED, Garland CF, Garland FC et al (2007) Optimal vitamin D status for colorectal cancer prevention: a quantitative meta analysis. Am J Prev Med 32(3):210–216

    Article  PubMed  Google Scholar 

  28. Goodwin PJ, Ennis M, Pritchard KI et al (2009) Prognostic effects of 25-hydroxyvitamin D levels in early breast cancer. J Clin Oncol 27(23):3757–3763

    Article  PubMed  CAS  Google Scholar 

  29. Garland CF, Gorham ED, Mohr SB et al (2009) Vitamin D for cancer prevention: global perspective. Ann Epidemiol 19(7):468–483

    Article  PubMed  Google Scholar 

  30. Gröber U (2010) Vitamin D—an old vitamin in a new perspective. Med Monatsschr Pharm 33:376–383

    PubMed  Google Scholar 

  31. Holick MF (2007) Vitamin D deficiency. N Engl J Med 357(3):266–281

    Article  PubMed  CAS  Google Scholar 

  32. Santini D, Galluzzo S, Vincenzi B et al (2010) Longitudinal evaluation of vitamin D plasma levels during anthracycline- and docetaxel-based adjuvant chemotherapy in early-stage breast cancer patients. Ann Oncol 21(1):185–186

    Article  PubMed  CAS  Google Scholar 

  33. Gröber U, Kisters K (2012) Influence of drugs on vitamin D and calcium metabolism. Dermatoendocrinol 4 (Epub ahead of print)

  34. Fink M (2011) Vitamin D deficiency is a cofactor of chemotherapy-induced mucocutaneous toxicity and dysgeusia. J Clin Oncol 29(4):e81–e82

    Article  PubMed  Google Scholar 

  35. Prieto-Alhambra D, Javaid MK, Servitja S et al (2011) Vitamin D threshold to prevent aromatase inhibitor-induced arthralgia: a prospectiv cohort study. Breast Cancer Res Treat 125(3):869–878

    Article  PubMed  CAS  Google Scholar 

  36. Khan QJ, Reddy PS, Kimler BF et al (2010) Effect of vitamin D supplementation on serum 25-hydroxy vitamin D levels, joint pain, and fatigue in women starting adjuvant letrozole treatment for breast cancer. Breast Cancer Res Treat 119(1):111–118

    Article  PubMed  CAS  Google Scholar 

  37. Carmel AS, Shieh A, Bang H et al (2012) The 25(OH)D level needed to maintain a favorable bisphosphonate response is ≥ 33 ng/ml. Osteoporos Int (Epub ahead of print)

  38. Clark LC, Combs GF, Turnbull BW et al (1996) Effects of selenium supplementation for cancer prevention in patients with carcinoma of the skin. J Am Med Assoc 276:1957–1963

    Article  CAS  Google Scholar 

  39. Lippmann SM, Klein EA, Goodman PJ et al (2009) Effect of selenium and vitamin E on risk of prostate cancer and other cancers: the selenium and vitamin E cancer prevention trial (SELECT). JAMA 301:39–51

    Article  Google Scholar 

  40. Dennert G, Zwahlen M, Brinkman M et al (2011) Selenium for preventing cancer (Review). Cochrane Database Syst Rev 11(5):CD005195

    Google Scholar 

  41. Bleys J, Navas-Acien A, Guallar E (2008) Serum selenium levels and all cause, cancer, and cardiovascular mortality among US adults. Arch Intern Med 168:404–410

    Article  PubMed  CAS  Google Scholar 

  42. Duffield-Lillico AJ, Dalkin BL, Reid ME et al (2003) Nutritional Prevention of Cancer Study Group. BJU Int 91:608–612

    Article  PubMed  CAS  Google Scholar 

  43. Lawenda BD, Kelly KM, Ladas EJ et al (2008) Should supplemental antioxidant administration be avoided during chemotherapy and radiation therapy? J Natl Cancer Inst 100:773–783

    Article  PubMed  CAS  Google Scholar 

  44. Lin LC, Que J, Lin KL et al (2008) Effects of zinc supplementation on clinical outcomes in patients receiving radiotherapy for head and neck cancers: a double-blinded randomized study. Int J Radiat Oncol Biol Phys 70:368–373

    Article  PubMed  CAS  Google Scholar 

  45. Lin YS, Lin LC, Lin SW (2009) Effects of zinc supplementation on the survival of patients who received concomitant chemotherapy and radiotherapy for advanced nasopharyngeal carcinoma: follow-up of a double-blind randomized study with subgroup analysis. Laryngoscope 119:1348–1352

    Article  PubMed  CAS  Google Scholar 

  46. Hu YJ, Chen Y, Zhang YQ et al (1997) The protective role of selenium on the toxicity of cisplatinum-contained chemotherapy regimen in cancer patients. Biol Trace Elem Res 56:331–341

    Article  PubMed  CAS  Google Scholar 

  47. Sieja K, Talerczyk M (2004) Selenium as an element in the treatment of ovarian cancer in women receiving chemotherapy. Gynecol Oncol 93:320–327

    Article  PubMed  CAS  Google Scholar 

  48. Asfour IA, Shazly SE, Fayek MH et al (2006) Effect of high-dose sodium selenite therapy on polymorphonuclear leukocyte apoptosis in non-Hodgkin’s lymphoma patients. Biol Trace Elem Res 110:19–32

    Article  PubMed  CAS  Google Scholar 

  49. Asfour IA, Fayek MH, Raouf S et al (2007) The impact of high-dose sodium selenite therapy on Bcl-2 expression in adult non-Hodgkin’s lymphoma patients: correlation with response and survival. Biol Trace Elem Res 120:1–10

    Article  PubMed  CAS  Google Scholar 

  50. Asfour IA, El-Tehewi MM, Ahmed MH et al (2009) High-dose sodium selenite can induce apoptosis of lymphoma cells in adult patients with non-Hodgkin’s lymphoma. Biol Trace Elem Res 127:200–210

    Article  PubMed  CAS  Google Scholar 

  51. Büntzel J, Riesenbeck D, Glatzel M et al (2010) Limited effects of selenium substitution in the prevention of radiation-associated toxicities. Results of a randomized study in head neck cancer patients. Anticancer Res 30:1829–1832

    PubMed  Google Scholar 

  52. Mücke R, Schomburg L, Glatzel M (2010) Multicenter, phase III trial comparing selenium supplementation with observation in gynecologic radiation oncology. Int J Radiat Oncol Biol Phys 70:825–835

    Google Scholar 

  53. Cruciani RA, Dvorkin E, Homel P et al (2004) L-carnitine supplementation for the treatment of fatigue and depressed mood in cancer patients with carnitine deficiency: a preliminary analysis. Ann N Y Acad Sci 1033:168–176

    Article  PubMed  CAS  Google Scholar 

  54. De Grandis D (2007) Acetyl-L-carnitine for the treatment of chemotherapy-induced peripheral neuropathy: a short review. CNS Drugs 21(Suppl 1):39–43

    Article  Google Scholar 

  55. Jin HW, Flatters SJ, Xiao WH et al (2008) Prevention of paclitaxel-evoked painful peripheral neuropathy by acetyl-L-carnitine: effects on axonal mitochondria, sensory nerve fiber terminal arbors, and cutaneous Langerhans cells. Exp Neurol 210(1):229–237

    Article  PubMed  CAS  Google Scholar 

  56. Bianchi G, Vitali G, Caraceni A et al (2005) Symptomatic and neurophysiological responses of paclitaxel- or cisplatin-induced neuropathy to oral acetyl-L-carnitine. Eur J Cancer 41(12):1746–1750

    Article  PubMed  CAS  Google Scholar 

  57. Sayed-Ahmed MM, Salman TM, Gaballah HE et al (2001) Propionyl-L-carnitine as protector against adriamycin-induced cardiomyopathy. Pharmacol Res 43(6):513–520

    Article  PubMed  CAS  Google Scholar 

  58. Wenzel U, Nickel A, Daniel H (2005) Increased carnitine-dependent fatty acid uptake into mitochondria of human colon cancer cells induces apoptosis. J Nutr 135(6):1510–1514

    PubMed  CAS  Google Scholar 

  59. Kraft M, Kraft K, Gärtner S et al (2012) L-Carnitine-supplementation in advanced pancreatic cancer (CARPAN) – a randomized multicentre trial. Nutr J 11:52

    Article  PubMed  CAS  Google Scholar 

  60. Hockenberry MJ, Hooke MC, Gregurich M et al (2009) Carnitine plasma levels and fatigue in children/adolescents receiving cisplatin, ifosfamide, or doxorubicin. J Pediatr Hematol Oncol 31(9):664–669

    Article  PubMed  CAS  Google Scholar 

  61. Gröber U, Hübner J, Holzhauer P (2010) Vitamin C in der komplementären Onkologie. Onkologe 16:303–313

    Google Scholar 

  62. Nechuta S, Lu W, Chen Z et al (2011) Vitamin supplement use during breast cancer treatment and survival: a prospective cohort study. Cancer Epidemiol Biomarkers Prev 20(2):262–271

    Article  PubMed  CAS  Google Scholar 

  63. Shimpo K, Nagatsu T, Yamada K et al (1991) Ascorbic acid and adriamycin toxicity. Am J Clin Nutr 54(6 Suppl):1298S–1301S

    PubMed  CAS  Google Scholar 

  64. Kurbacher CM, Wagner U, Kolster B et al (1996) Ascorbic acid (vitamin C) improves the antineoplastic activity of doxorubicin, cisplatin, and paclitaxel in human breast carcinoma cells in vitro. Cancer Lett 103(2):183–189

    Article  PubMed  CAS  Google Scholar 

  65. Chen Q, Espey MG, Sun AY et al (2008) Pharmacologic doses of ascorbate act as prooxidant and decrease growth of aggressive tumor xenografts in mice. PNAS 105(32):11037–11038

    Article  Google Scholar 

  66. Shinozaki K, Hosokawa Y, Hazawa M et al (2011) Ascorbic acid enhances radiation-induced apoptosis in an HL60 human leukemia cell line. J Radiat Res 52(2):229–237

    Article  PubMed  CAS  Google Scholar 

  67. Herst PM, Broadley KW, Harper JL et al (2012) Pharmacological concentrations of ascorbate radiosensitize glioblastoma multiforme primary cells by increasing oxidative DNA damage and inhibiting G2/M arrest. Free Radic Biol Med 52(8):1486–1493

    Article  PubMed  CAS  Google Scholar 

  68. Drisko JA, Chapman J, Hunter VJ (2003) The use of antioxidants with first-line chemotherapy in two cases of ovarian cancer. J Am Coll Nutr 22(2):118–123

    PubMed  Google Scholar 

  69. Vollbracht C, Schneider B, Leendert V et al (2011) Intravenous vitamin C administration improves quality of life in breast cancer patients during chemo-/radiotherapy and aftercare: results of a retrospective, multicentre, epidemiological cohort study in Germany. In Vivo 25(6):983–990

    PubMed  CAS  Google Scholar 

  70. Mücke R (2007) Komplementärer Seleneinsatz in der Onkologie. Onkologe 13: 477–480

    Article  Google Scholar 

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Authors and Affiliations

  1. Akademie für Mikronährstoffmedizin, Zweigertstraße 55, 45130, Essen, Deutschland

    U. Gröber, P. Holzhauer & K. Kisters

  2. Klinik für Strahlentherapie, Klinikum Lippe GmbH, Lemgo, Deutschland

    R. Mücke

  3. Klinik für Strahlentherapie und Radio-Onkologie, Ruhr Universität Bochum, Bochum, Deutschland

    R. Mücke & I.A. Adamietz

  4. Innere Medizin II - Onkologie und Komplementärmedizin, Klinik Bad Trissl, Oberaudorf, Deutschland

    P. Holzhauer

  5. Medizinische Klinik I, St. Anna Hospital, Herne, Deutschland

    K. Kisters

  6. Klinik für Hals-, Nasen- und Ohrenheilkunde, Südharz-Krankenhaus Nordhausen gGmbH, Nordhausen, Deutschland

    J. Büntzel

  7. Klinik für Strahlentherapie und Radioonkologie, Franziskus Hospital Bielefeld gGmbH, Bielefeld, Deutschland

    O. Micke

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  1. U. Gröber
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Correspondence to U. Gröber.

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Gröber, U., Mücke, R., Adamietz, I. et al. Komplementärer Einsatz von Antioxidanzien und Mikronährstoffen in der Onkologie. Onkologe 19, 136–143 (2013). https://doi.org/10.1007/s00761-012-2385-9

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