Cancer Treatment

The potential of vitamin B6 to treat cancer or prevent recurrence was studied as early as 1977, in which vitamin B6 showed some efficacy in preventing recurrence of stage I bladder cancer compared with placebo.9


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A study of intravesical bacillus Calmette-Guerin (BCG) with or without percutaneous BCG and with or without megadose vitamins, including vitamins A (40,000 U), B6 (100 mg), C (2000 mg), E (400 U), and zinc (90 mg), demonstrated significantly reduced rated of recurrence of transitional cell bladder cancer with the megadose vitamins compared with percutaneous BCG.10

Vitamin B6 and cantharidinate added to gemcitabine/platinum chemotherapy increased efficacy and decreased toxicity compared with the GP regimen alone in a small study of 86 patients with middle- to late-stage NSCLC.11

A double-blind, phase 3 study of 291 patients, however, showed no difference between vitamin B6 and placebo for recurrence of Ta and T1 transitional cell bladder cancer.12 An ancillary study of cancer chemoprevention trial among patients with cardiovascular disease also found no significant difference with 5 years of B vitamins supplementation and cancer outcomes.13

Prevention of Treatment Toxicity

The data regarding vitamin B6 as a preventative agent against chemotherapy toxicity, particularly hand-foot syndrome (HFS) and neurotoxicities, are also mixed.

A systematic review of 5 randomized, controlled trials including 607 patients concluded that there are inadequate data to support any recommendation for vitamin B6 to prevent HFS associated with chemotherapy.

The dose of vitamin B6 may be important, however, as 1 study showed that 400 mg of vitamin B6 was more effective than 200 mg to prevent grade 2 and 3 HFS (risk ratio [RR], 0.55; 95% CI: 0.33-0.92).14 Other studies found no significant difference in HFS prevention with 60 mg, 100 mg, 150 mg, 200 mg, or 300 mg of vitamin B6 compared with placebo.14,15,16

Similarly, the addition of 50 mg of vitamin B6 to capecitabine reduced the need for capecitabine dose modifications (37% vs 23%; RR, 0.59; 95% CI: 0.29-1.20; P = .15) and the incidence of grade 3-4 HFS (9% vs 17%; OR, 0.51; 95% CI: 0.15-1.6; P = .26), but was not significant.17

A study of 112 patients receiving vincristine for stage II breast cancer demonstrated no difference in the incidence or severity of neurotoxicity with vitamin B6 compared with vincristine alone.18

Another study of 248 patients with stage III to IV ovarian epithelial cancer demonstrated that although 300 mg of vitamin B6 reduced neurotoxicity caused by 1:4 cisplatin-hexamethylmelamine, the duration of response was shorter.19

Conclusions

The evidence for the use of vitamin B6 to prevent or treat cancer or reduce toxicity associated with chemotherapy is not clear, though 400 mg of vitamin B6 may be effective in reducing the incidence of HFS. The supplementation of vitamin B6, however, does not appear to increase the risk of cancers.

Reference

  1. Gruber BM. B-group vitamins: chemoprevention? Adv Clin Exp Med. 2016;25:561-8. doi: 10.17219/acem/33847
  2. Egnell M, Fassier P, Lécuyer L, et al. B-vitamin intake from diet and supplements and breast cancer risk in middle-aged women: results from the prospective NutriNet-Santé cohort. Nutrients. 2017;9:488-504. doi: 10.3390/nu9050488
  3. Hartman TJ, Woodson K, Stolzenberg-Solomon R, et al. Association of the B-vitamins pyridoxal 5′-phosphate (B(6)), B(12), and folate with lung cancer risk in older men. Am J Epidemiol. 2001;153:688-94.
  4. Zhang SM, Moore SC, Lin J, et al. Folate, vitamin B6, multivitamin supplements, and colorectal cancer risk in women. Am J Epidemiol. 2006;163:108-15.
  5. Figueiredo JC, Levine AJ, Grau MV, et al. Vitamins B2, B6, and B12 and risk of new colorectal adenomas in a randomized trial of aspirin use and folic acid supplementation. Cancer Epidemiol Biomarkers Prev. 2008;17:2136-45. doi: 10.1158/1055-9965.EPI-07-2895
  6. Song Y, Manson JE, Lee IM, et al. Effect of combined folic acid, vitamin B(6), and vitamin B(12) on colorectal adenoma. J Natl Cancer Inst. 2012;104:1562-75. doi: 10.1093/jnci/djs370
  7. Zhang SM, Cook NR, Albert CM, Gaziano JM, Buring JE, Manson JE. Effect of combined folic acid, vitamin B6, and vitamin B12 on cancer risk in women: a randomized trial. JAMA. 2008;300:2012-21. doi: 10.1001/jama.2008.555
  8. Hankey GJ, Eikelboom JW, Yi Q, et al. Treatment with B vitamins and incidence of cancer in patients with previous stroke or transient ischemic attack: results of a randomized placebo-controlled trial. Stroke. 2012;43:1572-7.
  9. Byar D, Blackard C. Comparisons of placebo, pyridoxine, and topical thiotepa in preventing recurrence of stage I bladder cancer. Urology. 1977;10:556-61.
  10. Lamm DL, Riggs DR, Shriver JS, vanGilder PF, Rach JF, DeHaven JI. Megadose vitamins in bladder cancer: a double-blind clinical trial. J Urol. 1994;151:21-6.
  11. Wang B, Cui J. Treatment of mid-late stage NSCLC using sodium cantharidinate/vitamin B6/GP regimen in clinic. J Cancer Res Ther. 2014;10 Suppl 1:C79-C81. doi: 10.4103/0973-1482.139771
  12. Newling DW, Robinson MR, Smith PH, et al. Tryptophan metabolites, pyridoxine (vitamin B6) and their influence on the recurrence rate of superficial bladder cancer. Results of a prospective, randomised phase III study performed by the EORTC GU Group. EORTC Genito-Urinary Tract Cancer Cooperative Group. Eur Urol. 1995;27:110-6.
  13. Andreeva VA, Touvier M, Kesse-Guyot E, Julia C, Galan P, Hercberg S. B vitamin and/or ω-3 fatty acid supplementation and cancer: ancillary findings from the supplementation with folate, vitamins B6 and B12, and/or omega-3 fatty acids (SU.FOL.OM3) randomized trial. Arch Intern Med. 2012;172:540-7. doi: 10.1001/archinternmed.2011
  14. Chen M, Zhang L, Wang Q, Shen J. Pyridoxine for prevention of hand-foot syndrome caused by chemotherapy: a systematic review. PLoS One. 2013;8:e72245. doi: 10.1371/journal.pone.0072245
  15. von Gruenigen V, Frasure H, Fusco N, et al. A double-blind, randomized trial of pyridoxine versus placebo for the prevention of pegylated liposomal doxorubicin-related hand-foot syndrome in gynecologic oncology patients. Cancer. 2010;116:4735-43. doi: 10.1002/cncr.25262
  16. Ota M, Tatsumi K, Suwa H, et al. The effect of pyridoxine for prevention of hand-foot syndrome in colorectal cancer patients with adjuvant chemotherapy using capecitabine: a randomized study. Hepatogastroenterology. 2014;61:1008-13.
  17. Corrie PG, Bulusu R, Wilson CB, et al. A randomised study evaluating the use of pyridoxine to avoid capecitabine dose modifications. Br J Cancer. 2012;107:585-7. doi: 10.1038/bjc.2012.318
  18. Jackson DV Jr, Pope EK, McMahan RA, et al. Clinical trial of pyridoxine to reduce vincristine neurotoxicity. J Neurooncol. 1986;4:37-41.
  19. Wiernik PH, Yeap B, Vogl SE, et al. Hexamethylmelamine and low or moderate dose cisplatin with or without pyridoxine for treatment of advanced ovarian carcinoma: a study of the Eastern Cooperative Oncology Group. Cancer Invest. 1992;10:1-9.