Prevention of Chemotherapy-induced Toxicities

Mucositis

Several randomized, controlled trials demonstrated reduced severity of mucositis among patients with HNC who received zinc supplementation compared with placebo.


Continue Reading

A randomized, placebo-controlled trial of 30 patients demonstrated reduced severity, longer time to development, and earlier improvement of mucositis with zinc sulfate compared with placebo.14 Another trial also found reduced severity of mucositis with zinc supplementation compared with placebo among patients with HNC who underwent radiotherapy, but not among those with nasopharyngeal carcinoma.15,16

A randomized, placebo-controlled trial of 40 patients with HNC who received radiotherapy or chemoradiotherapy demonstrated reduced prevalence (40% vs 70.5%, respectively; P < .0001), severity (P = .0001), and lower Oral Mucositis Assessment Scale (OMAS; P = .0001) with zinc supplementation (30 mg) compared with placebo starting 10 days before treatment and for 2 weeks after treatment completion.17

Two other randomized, placebo-controlled studies, however, found no significant difference in incidence or severity of mucositis with zinc supplementation.18,19

Taste

A randomized, placebo-controlled trial of 169 patients with HNC found no difference in radiotherapy-induced taste alterations (dysgeusia) among patients who received zinc or placebo supplementation.20,21

Another randomized, placebo-controlled study, however, demonstrated mitigated worsening and quicker recovery of taste acuity with zinc sulfate compared with placebo among patients receiving radiotherapy.22

Related Articles

Conclusions

Though the data remain mixed, there is no strong evidence for the risk reduction of several different types of cancer with zinc supplementation as part of a multivitamin.

Several studies demonstrated improved outcomes in terms of radiotherapy-induced mucositis or taste alteration with zinc sulfate supplementation among patients with HNC, though these findings are inconsistent.

Overall, the evidence for the benefits of zinc to prevent cancer or mitigate anticancer treatment toxicity is mixed, though zinc supplementation is well-tolerated and does not appear to cause harm.

References

  1. Zinc: fact sheet for health professionals. National Institutes of health Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Zinc-HealthProfessional/. Updated February 11, 2016. Accessed September 6, 2017.
  2. Hercberg S, Ezzedine K, Guinot C, et al. Antioxidant supplementation increases the risk of skin cancers in women but not in men. J Nutr. 2007;137:2098-105. doi: 0022-3166/07
  3. Hercberg S, Kesse-Guyot E, Druesne-Pecollo N, et al. Incidence of cancers, ischemic cardiovascular diseases and mortality during 5-year follow-up after stopping antioxidant vitamins and minerals supplements: a postintervention follow-up in the SU.VI.MAX Study. Int J Cancer. 2010;127:1875-81. doi: 10.1002/ijc.25201
  4. Meyer F, Galan P, Douville P, et al. Antioxidant vitamin and mineral supplementation and prostate cancer prevention in the SU.VI.MAX trial. Int J Cancer. 2005;116:182-6. doi: 10.1002/ijc.21058
  5. Stratton J, Godwin M. The effect of supplemental vitamins and minerals on the development of prostate cancer: a systematic review and meta-analysis. Fam Pract. 2011;28:243-52. doi: 10.1093/fampra/cmq115
  6. Li Q, Chuang SC, Eluf-Neto J, et al. Vitamin or mineral supplement intake and the risk of head and neck cancer: pooled analysis in the INHANCE consortium. Int J Cancer. 2012;131:1686-99. doi:10.1002/ijc.27405
  7. Dawsey SP, Hollenbeck A, Schatzkin A, Abnet CC. A prospective study of vitamin and mineral supplement use and the risk of upper gastrointestinal cancers. PLoS ONE. 9:e88774. doi: 10.1371/journal.pone.0088774
  8. Bonelli L, Puntoni M, Gatteschi B, et al. Antioxidant supplement and long-term reduction of recurrent adenomas of the large bowel. A double-blind randomized trial. J Gastroenterol. 2013;48:698-705. doi: 10.1007/s00535-012-0691-z
  9. 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.
  10. Kamangar F, Qiao YL, Yu B, et al. Lung cancer chemoprevention: a randomized, double-blind trial in Linxian, China. Cancer Epidemiol Biomarkers Prev. 2006;15:1562-4. doi: 10.1158/1055-9965.EPI-06-0316
  11. Qu CX, Kamangar F, Fan JH, et al. Chemoprevention of primary liver cancer: a randomized, double-blind trial in Linxian, China. J Natl Cancer Inst. 2007;99:1240-7. doi: 10.1093/jnci/djm084
  12. Lin LC, Que J, Lin KL, Leung HW, Lu CL, Chang CH. 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. 2008;70:368-73.
  13. Lin YS, Lin LC, Lin SW. 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. 2009;119:1348-52. doi: 10.1002/lary.20524
  14. Ertekin MV, Koc M, Karslioglu I, Sezen O. Zinc sulfate in the prevention of radiation-induced oropharyngeal mucositis: a prospective, placebo-controlled, randomized study. Int J Radiat Oncol Biol Phys. 2004;58:167-74.
  15. Lin LC, Que J, Lin LK, Lin FC. Zinc supplementation to improve mucositis and dermatitis in patients after radiotherapy for head-and-neck cancers: a double-blind, randomized study. Int J Radiat Oncol Biol Phys. 2006;65:745-50.
  16. Lin YS, Lin LC, Lin SW, Chang CP. Discrepancy of the effects of zinc supplementation on the prevention of radiotherapy-induced mucositis between patients with nasopharyngeal carcinoma and those with oral cancers: subgroup analysis of a double-blind, randomized study. Nutr Cancer. 2010;62:682-91. doi: 10.1080/01635581003605532
  17. Moslemi D, Babaee N, Damavandi M, Pourghasem M, Moghadamnia AA. Oral zinc sulphate and prevention of radiation-induced oropharyngealmucositis in patients with head and neck cancers: A double blind, randomized controlled clinical trial. Int J Rad Res. 2014;12:235-41.
  18. Mansouri A, Hadjibabaie M, Iravani M, et al. The effect of zinc sulfate in the prevention of high-dose chemotherapy-induced mucositis: a double-blind, randomized, placebo-controlled study. Hematol Oncol. 2012;30:22-6. doi: 10.1002/hon.999
  19. Sangthawan D, Phungrassami T, Sinkitjarurnchai W. A randomized double-blind, placebo-controlled trial of zinc sulfate supplementation for alleviation of radiation-induced oral mucositis and pharyngitis in head and neck cancer patients. J Med Assoc Thai. 2013;96:69-76.
  20. Halyard MY, Jatoi A, Sloan JA, et al. Does zinc sulfate prevent therapy-induced taste alterations in head and neck cancer patients? Results of phase III double-blind, placebo-controlled trial from the North Central Cancer Treatment Group (N01C4). Int J Radiat Oncol Biol Phys. 2007;67:1318-22. doi:10.1016/j.ijrobp.2006.10.046
  21. Lyckholm L, Heddinger SP, Parker G, et al. A randomized, placebo controlled trial of oral zinc for chemotherapy-related taste and smell disorders. J Pain Palliat Care Pharmacother. 2012;26:111-4. doi: 10.3109/15360288.2012.676618
  22. Ripamonti C, Zecca E, Brunelli C, et al. A randomized, controlled clinical trial to evaluate the effects of zinc sulfate on cancer patients with taste alterations caused by head and neck irradiation. Cancer. 1998;82:1938-45.