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Recommendations Summary

ONC: Lung Cancer: Chemotherapy and Use of Antioxidant Vitamins C, E and Beta-Carotene Oral Supplements 2007

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

• Recommendation(s)

  ONC: Lung cancer: Chemotherapy and use of Antioxidant Supplements

  The use of antioxidants (vitamin C, vitamin E, beta-carotene, selenium) above the tolerable upper intake level to improve treatment outcomes in patients with advanced non-small cell lung cancer undergoing chemotherapy is not recommended. In this population, use of high-dose multiple oral antioxidants did not significantly influence response to treatment, survival, survival time and toxicity. More studies are needed.

  Rating: Weak
  Imperative

  • Risks/Harms of Implementing This Recommendation

    There are no potential risks or harms associated with application of this recommendation.

  • Conditions of Application

     No conditions limit the application of this recommendation.

  • Potential Costs Associated with Application

    No obvious costs are associated with the application of this recommendation.

  • Recommendation Narrative

    • In a positive quality, PRCT (Pathak et al, 2005) found supplementation with high-dose multiple antioxidants vitamin C (ascorbic acid) 6100 mg/day; vitamin E (dl-alphatocopherol succinate, also containing selenium, copper sulfate, and zinc sulfate) 1, 050 mg/day; vitamin A (synthetic beta-carotene) 60 mg/day, did not significantly influence response to treatment, survival, survival time and toxicity in patients receiving chemotherapy (paclitaxel and carboplatin) for advanced stage (IIIb and IV) non-small cell lung cancer.
    • The biologically active forms of the antioxidants were not used and there were no assessment of the patients’ serum levels of antioxidants.
    • More studies are needed.

  • Recommendation Strength Rationale

    • Based on one positive quality RCT, conclusion statement is a Grade III.

  • Minority Opinions

    Consensus reached.

• Supporting Evidence

  The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

  Is there a relationship between supplementation of multiple antioxidants and an interaction with paclitaxel and carboplatin chemotherapy protocols and tolerance of chemotherapy treatment in patients with non-small cell lung cancer?

  • References

    Pathak AK, Bhutani M, Guleria R, Bal S, Mohan A, Mohanti BK, Sharma A, Pathak R, Bhardwaj NK, Prasad KN, Kochupillai V. Chemotherapy alone vs. chemotherapy plus high dose multiple antioxidants in patients with advanced non small cell lung cancer. J Am Coll Nutr. 2005 Feb;24(1):16-21.

  • References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process

    Dietary Reference Intakes: Elements. Institute of Medicine of the National Acadamies. Accessed 5/25/2006: http://www.iom.edu/Object.File/Master/7/294/0.pdf

    Dietary Reference Intakes: Vitamins. Institute of Medicine of the National Academies. Accessed 5/25/2006: http://www.iom.edu/Object.File/Master/7/296/webtablevitamins.pdf