Efficacy and Interaction of Antioxidant Supplements as Adjuvant Therapy in Cancer Treatment: A Systematic Review

Abstract

Oxidative stress is a key component in carcinogenesis. Although radiation produces reactive oxygen species, some anticancer agents such as alkylating agents, platinum and antitumor antibiotics exert cytotoxicity by generating free radicals. Nonenzymatic exogenous antioxidants such as vitamins, minerals, and polyphenols can quench ROS activity. However, whether antioxidants alter antitumor effects during radiotherapy and some types of chemotherapy remains unclear. In the present study, we reviewed antioxidants as an adjuvant therapy for cancer patients during chemotherapy or radiotherapy. Electronic literature searches were performed to select all randomized controlled clinical trials (RCTs) in which antioxidants were administered to cancer patients along with chemotherapy or radiotherapy. Articles or abstracts written in English were included. In total, 399 reports received primary screening. Duplicated articles and those meeting the exclusion criteria (not RCT, not human, and no oral administration) were excluded. Finally, 49 reports matching the inclusion criteria were included. It was difficult to determine whether antioxidants affect treatment outcomes or whether antioxidants ameliorate adverse effects induced by chemotherapy and radiotherapy. It is desirable to use an evidence-based method to select supplements best suited to cancer patients. Although there are many opinions about risks or benefits of antioxidant supplementation, we could mostly conclude that the harm caused by antioxidant supplementation remains unclear for patients during cancer therapy, except for smokers undergoing radiotherapy.

Keywords: antioxidant; cancer; chemotherapy; radiotherapy; supplement; vitamin.

Figure 1.

In total, 399 reports were primarily screened. Thereafter, duplicated articles and those that met the exclusion criteria were excluded. Finally, 49 reports that met our inclusion criteria were included: 22 vitamin reports (17 chemotherapy, 8 radiotherapy, including 3 duplicates), 12 phytochemicals and related compounds reports (10 chemotherapy, 2 radiotherapy), 2 amino acid and related substances reports (both chemotherapy) and 13 mineral reports (5 chemotherapy, 8 radiotherapy). Abbreviation: RCT, randomized controlled trial.