Intravenous Vitamin C

Common Uses in Cancer Care

IVC is most commonly prescribed to improve quality of life, to slow cancer progression and to reduce cancer-treatment related symptoms, for example fatigue, nausea and lack of appetite. The administration of IVC results in far higher serum levels of vitamin C than oral administration of an identical dose. IV infusion may raise serum levels of vitamin C 70-fold compared to those that may be achieved through oral dosing alone. IV administration bypasses the gastrointestinal controls within the body that prevent the absorption of vitamin C when taken orally. Only the IV route of administration has been documented to achieve sufficient serum levels to observe an anticancer effect.

Mechanism of Action:

A) H2O2 Production: Administration of IVC has been shown to cause measurable increases in extracellular H2O2, which has been shown to cause cell death in numerous cancer cell lines by necrosis while leaving normal human cells unharmed.

B) Pro-oxidant effect: Despite vitamin C’s known action as an antioxidant when taken orally, the high serum concentrations of vitamin C that result from IV administration lead to the generation of free radicals in the extracellular fluid, causing the infused vitamin C to behave as a pro-oxidant compound in vivo. The actions of a pro-oxidant are the opposite to an antioxidant in that the pro- oxidant will generate free radicals, rather than quench them.

Clinical Evidence Related to Quality of life

The clinical trials that have been published have included only patients with advanced disease. These studies have assessed the impact of IVC on quality of life. In one trial, quality of life remained stable while quality of life improved in another. Breast cancer patients who used IVC in combination with standard care demonstrated improved quality of life as compared to those who used standard care only. These results are notable, as quality of life would otherwise be expected to decrease in this population of patients with advanced disease.

Clinical Evidence Related to Slow Cancer Progression

IVC is not considered a curative therapy for cancer, however, a handful of well-documented case reports suggest that treatment with IVC is associated with tumour regression and remission, and unexpectedly long survival times. These outcomes are supported by animal studies conducted using high doses of vitamin C obtainable by IV infusion that demonstrate reduced tumour size and decreased tumour growth rate. Similarly, in vitro evidence demonstrates sensitivity of a number of cell lines to treatment with vitamin C.

IVC IN COMBINATION WITH STANDARD CARE

Recent clinical studies have examined the combination of IVC with concurrent chemotherapy based on hypotheses that IVC may reduce the toxicity of standard treatment, improve treatment response, or both. In one study that included women with breast cancer, cancer-related symptoms and treatment side effects were reduced in those women who were treated with IVC. In a separate trial conducted in women with ovarian cancer, women who received IVC treatment reported fewer side effects and a trend towards benefit in disease-related outcomes. Other therapies used in these trials included epirubicin, cyclophosphamide, methotrexate, fluorouracil, paclitaxel and cisplatin.

A recent trial included people newly diagnosed with stage IV pancreatic cancer who were treated with IVC in combination with gemcitabine and erlotinib as first line treatment. Eight of the 9 patients who completed the trial had a reduction in the size of their primary tumour and tumour size was stable in the ninth patient. These results are not typical for treatment with either gemcitabine or gemcitabine plus erlotinib alone.

Animal and cell-line studies suggest a synergistic effect when some chemotherapeutic agents are combined with pharmacologic doses of vitamin C. Published evidence appears to support concurrent use of IVC with: gemcitabine (20), carboplatin (21), cisplatin (3, 22, 23), etoposide (3), 5-fluorouracil (3, 22, 24), epirubicin (24), doxorubicin (3, 16, 23), paclitaxel (3, 23), docetaxel (24), and irinotecan (24). In these studies, the combination of IVC plus chemotherapy was related to increased tumour inhibition and decreased tumour growth rate as compared to either IVC or chemotherapy alone.

DISCLAIMER

PCNM and Ottawa Integrative Cancer Clinic have prepared this information to share results and review the research evidence related to IVC within cancer patient care.  Every effort is made to ensure the information is accurate at the time it is published. Prior to using a new therapy or product, always consult a licensed health care provider. This information should not be interpreted as medical advice nor should it replace the advice of a qualified health care provider.

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