Outcomes After Anticancer Treatment

A multicenter, double-blind trial randomly assigned 540 patients with stage I or II head and neck cancer to receive alpha-tocopherol (400 IU per day) and beta-Carotene (30 mg/day) or placebo on their first day of radiation and continued for 3 years.17 beta-Carotene was discontinued, however, because of ethical concerns.

Vitamin E supplementation increased the risk of second primary cancers (HR, 2.88; 95% CI, 1.56-5.31) and recurrence/second primary cancer (HR, 1.86, 95% CI, 1.27-2.72) compared with placebo during the intervention period, but trended toward a decreased risk after supplementation was discontinued (HR, 0.41; 95% CI, 0.16-1.03 and HR, 0.71; 95% CI, 0.33-1.53, respectively).

An analysis of the ATBC trial, however, found improved survival among patients with prostate cancer who had high serum levels of alpha-tocopherol at baseline (HR, 0.67; 95% CI, 0.45-1.00) and who received alpha-tocopherol supplementation and also had high baseline (HR, 0.51; 95% CI, 0.20-0.90) or 3-year (HR, 0.26; 95% CI, 0.09-0.71) serum levels.18

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Prevention of Treatment-related Toxicities

Multiple trials have evaluated the effect of vitamin E supplementation on reducing toxicities associated with anticancer treatments.

Several randomized, controlled trials demonstrated that vitamin E supplementation improved paclitaxel- or cisplatin-associated neurotoxicity compared with placebo.19-23 Another study found that vitamin E supplementation improved hand-foot syndrome caused by sorafenib among patients with hepatocellular carcinoma.24

Vitamin E did not, however, improve chemotherapy-induced peripheral sensory neuropathy.25,26

Vitamin E supplementation also improved radiation-induced toxicities. In one trial, vitamin E reduced severe acute adverse effects during radiation (odds ratio [OR], 0.72; 95% CI, 0.52-1.02), which was significant when vitamin E was combined with beta-Carotene (OR, 0.38; 95% CI, 0.21-0.71), though there was no improvement in quality of life.27 Local recurrence was, however, numerically higher with supplementation compared with placebo (HR, 1.37; 95% CI, 0.93-2.02).

Topically applied vitamin E supplementation improved radiation-induced vaginal toxicity and pain associated with radiotherapy for the treatment of gynecologic tumors.28 Oral vitamin E improved radiation-induced mucositis, salivary gland dysfunction, and xerostomia.29-31

Conclusions

The available evidence suggests that vitamin E supplementation does not prevent cancer, though one large study found a small increased risk of prostate cancer.

Vitamin E supplementation appears to reduce the risk of chemotherapy-induced neurotoxicity and several radiation-induced toxicities, though one study found increased recurrence rates with its use.

References

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