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High-Dose Vitamin C (PDQ®)
- Questions and Answers About High-Dose Vitamin C
- Changes to This Summary (04/11/2013)
- General CAM Information
- Evaluation of CAM Approaches
- Questions to Ask Your Health Care Provider About CAM
- To Learn More About CAM
- About PDQ
- Vitamin C is a nutrient found in food and dietary supplements. It is an antioxidant and also plays a key role in making collagen (see Question 1).
- High-dose vitamin C has been studied as a treatment for patients with cancer since the 1970s (see Question 2).
- High-dose vitamin C may be given by intravenous (IV) infusion or taken by mouth (see Question 2).
- Laboratory studies have shown that high doses of vitamin C may slow the growth and spread of prostate, pancreatic, liver, colon, and other types of cancer cells (see Question 5).
- Some laboratory studies have shown that combining vitamin C with anticancer therapies may be helpful, while other studies have shown that certain forms of vitamin C may make chemotherapy less effective (see Question 5).
- Animal studies have shown that high-dose vitamin C treatment blocks tumor growth in certain models of pancreatic, liver, prostate, and ovarian cancers, sarcoma, and malignant mesothelioma (see Question 5).
- Some animal studies have shown that combining vitamin C with anticancer therapies may be helpful, while other studies have shown that vitamin C may interfere with the anticancer action of some drugs (see Question 5).
- Some human studies of IV vitamin C or vitamin C taken by mouth in patients with cancer have shown improved quality of life, as well as improvements in physical, mental, and emotional functions, symptoms of fatigue, nausea and vomiting, pain, and appetite loss (see Question 6).
- Studies of vitamin C combined with other drugs in patients with cancer have shown mixed results (see Question 6).
- Intravenous high-dose ascorbic acid has caused very few side effects in clinical trials (see Question 7).
- The U.S. Food and Drug Administration (FDA) has not approved the use of high-dose vitamin C as a treatment for cancer or any other medical condition (see Question 9).
Questions and Answers About High-Dose Vitamin CWhat is high-dose vitamin C? Vitamin C (also called L-ascorbic acid or ascorbate) is a nutrient that humans must get from food or dietary supplements since it cannot be made in the body. Vitamin C is an antioxidant and helps prevent oxidative stress. It also works with enzymes to play a key role in making collagen.When taken by intravenous (IV) infusion, vitamin C can reach much higher levels in the blood than when it is taken by mouth. Studies suggest that these higher levels of vitamin C may cause the death of cancer cells in the laboratory.A severe deficiency (lack) of vitamin C in the diet causes scurvy, a disease with symptoms of extreme weakness, lethargy, easy bruising, and bleeding. The lack of vitamin C in patients with scurvy makes collagen thinner in texture; when vitamin C is given, collagen becomes thicker again. What is the history of the discovery and use of high-dose vitamin C as a complementary and alternative treatment for cancer? High-dose vitamin C has been studied as a treatment for patients with cancer since the 1970s. A Scottish surgeon named Ewan Cameron worked with Nobel Prize-winning chemist Linus Pauling to study the possible benefits of vitamin C therapy in clinical trials of cancer patients in the late 1970s and early 1980's. Surveys of healthcare practitioners at United States CAM conferences in recent years have shown that high-dose IV vitamin C is frequently given to patients as a treatment for infections, fatigue, and cancers, including breast cancer. What is the theory behind the claim that high-dose vitamin C is useful in treating cancer? More than fifty years ago, a study suggested that cancer was a disease of changes in connective tissue caused by a lack of vitamin C. In the 1970's, it was proposed that high-dose ascorbic acid could help build resistance to disease or infection and possibly treat cancer.Later studies showed that the levels of vitamin C that collect in the bloodstream depend on how it is taken. How is high-dose vitamin C administered? Vitamin C may be given by intravenous (IV) infusion or taken by mouth. Have any preclinical (laboratory or animal) studies been conducted using high-dose vitamin C? Laboratory studies and animal studies have been done to find out if high-dose vitamin C may be useful in preventing or treating cancer. Laboratory studiesMany laboratory studies have been done to find out how high-dose vitamin C may cause the death of cancer cells. The anticancer effect of vitamin C in different types of cancer cells involves a chemical reaction that makes hydrogen peroxide, which may kill cancer cells.Laboratory studies have shown the following: Treatment with high-dose vitamin C slowed the growth and spread of prostate, pancreatic, liver, colon, malignant mesothelioma, neuroblastoma, and other types of cancer cells.Combining high-dose vitamin C with certain types of chemotherapy may be more effective than chemotherapy alone: Ascorbic acid with arsenic trioxide may be more effective in ovarian cancer cells.Ascorbic acid with gemcitabine may be more effective in pancreatic cancer cells.Ascorbic acid with gemcitabine and epigallocatechin-3-gallate (EGCG) may be more effective in malignant mesothelioma cells.Another laboratory study suggested that combining high-dose vitamin C with radiation therapy killed more glioblastoma multiforme cells than radiation therapy alone. However, not all laboratory studies combining vitamin C with anticancer therapies have shown benefit. Combining dehydroascorbic acid, a particular form of vitamin C, with chemotherapy made it less effective in killing some kinds of cancer cells.Animal studiesStudies of high-dose vitamin C have been done in animal models (animals given a disease either the same as or like a disease in humans). Some of the studies showed the vitamin C helped kill more cancer cells: High-dose vitamin C blocked tumor growth in animal models of pancreatic, liver, prostate, sarcoma, and ovarian cancers and malignant mesothelioma.High-dose vitamin C combined with chemotherapy in a mouse model of pancreatic cancer showed that the combination treatment shrank tumors more than chemotherapy treatment alone. Another study showed that vitamin C made a type of light therapy more effective when used to treat mice injected with breast cancer cells.However, other animal studies have shown that vitamin C interferes with the anticancer action of certain drugs, including the following: Mouse models of human lymphoma and multiple myeloma treated with combinations of vitamin C and chemotherapy or the drug bortezomib had more tumor growth than mice treated with bortezomib alone. Have any clinical trials (research studies with people) of high-dose vitamin C been conducted? Several studies of high-dose vitamin C in patients with cancer have been done in recent years, including the following:Studies of vitamin C alone Intravenous (IV) vitamin C was studied in patients with breast cancer who were treated with adjuvant chemotherapy and radiation therapy. The study found that patients who received IV vitamin C had better quality of life and fewer side effects than those who did not.A study of IV vitamin C and high doses of vitamin C taken by mouth was done in patients with cancer that could not be cured. Vitamin C was shown to be a safe and effective therapy to improve quality of life in these patients, including physical, mental, and emotional functions, symptoms of fatigue, nausea and vomiting, pain, and appetite loss.Vitamin C has been shown to be safe when given to healthy volunteers and cancer patients at doses up to 1.5 g/kg, while screening out patients with certain risk factors who should avoid vitamin C. Studies have also shown that Vitamin C levels in the blood are higher when taken by IV than when taken by mouth, and last for more than 4 hours.Studies of vitamin C combined with other drugsStudies of vitamin C combined with other drugs have shown mixed results: In a small study of 14 patients with advanced pancreatic cancer, IV vitamin C was given along with chemotherapy and treatment with a targeted therapy. Patients had very few bad side effects from the vitamin C treatment. The nine patients who completed the treatment had stable disease as shown by imaging studies.In another small study of 9 patients with advanced pancreatic cancer, patients were given chemotherapy in treatment cycles of once per week for 3 weeks along with IV vitamin C twice per week for 4 weeks. These patients had disease that did not progress for a period of months. The combined treatment was well tolerated and no serious side effects were reported.Patients with acute myeloid leukemia, refractory metastatic colorectal cancer, or metastatic melanoma treated with vitamin C combined with other drugs had serious side effects and the disease got worse. Have any side effects or risks been reported from high-dose vitamin C? Intravenous high-dose ascorbic acid has caused very few side effects in clinical trials. However, high-dose vitamin C may be harmful in patients with certain risk factors. In patients with a history of kidney disorders, kidney failure has been reported after ascorbic acid treatment. Patients with a tendency to develop kidney stones should not be treated with high-dose vitamin C.Case reports have shown that patients with an inherited disorder called G-6-PD deficiency should not be given high doses of vitamin C, due to the risk of hemolysis (a condition in which red blood cells are destroyed).Since vitamin C may make iron more easily absorbed and used by the body, high doses of the vitamin are not recommended for patients with hemochromatosis (a condition in which the body takes up and stores more iron than it needs). Have any drug interactions been reported from combining high-dose vitamin C with anticancer drugs?A drug interaction is a change in the way a drug acts in the body when taken with certain other drugs. High-dose vitamin C, when combined with some anticancer drugs, may cause them to be less effective. So far, these effects have been seen only in some laboratory and animal studies. No clinical trials have been done to further research these drug interactions in humans. Combining vitamin C with an anticancer drug called bortezomib has been studied in cell cultures and in animal models. Bortezomib is a targeted therapy that blocks several molecular pathways in a cell, causing cancer cells to die. Several studies showed that vitamin C made bortezomib less effective, including in multiple myeloma cells. A study in mice transplanted with human prostate cancer cells, however, did not show that giving the mice different doses of vitamin C by mouth made bortezomib therapy less effective. An oxidized form of vitamin C called dehydroascorbic acid has been studied in cell cultures and in animals with tumors. Several studies have found that high doses of dehydroascorbic acid can interfere with the anticancer effects of several chemotherapy drugs. Dehydroascorbic acid is found in only small amounts in dietary supplements and in fresh foods.See Question 5 and Question 6 for more information on combining vitamin C with anticancer drugs. Is high-dose vitamin C approved by the U.S. Food and Drug Administration for use as a cancer treatment in the United States? The U.S. Food and Drug Administration (FDA) has not approved the use of high-dose vitamin C as a treatment for cancer or any other medical condition.Because dietary supplements are regulated as foods, not as drugs, FDA approval is not required unless specific claims about disease prevention or treatment are made.
Changes to This Summary (04/11/2013)
This is a new summary.
General CAM Information
Complementary and alternative medicine (CAM)—also referred to as integrative medicine—includes a broad range of healing philosophies, approaches, and therapies. A therapy is generally called complementary when it is used in addition to conventional treatments; it is often called alternative when it is used instead of conventional treatment. (Conventional treatments are those that are widely accepted and practiced by the mainstream medical community.) Depending on how they are used, some therapies can be considered either complementary or alternative. Complementary and alternative therapies are used in an effort to prevent illness, reduce stress, prevent or reduce side effects and symptoms, or control or cure disease.
Unlike conventional treatments for cancer, complementary and alternative therapies are often not covered by insurance companies. Patients should check with their insurance provider to find out about coverage for complementary and alternative therapies.
Cancer patients considering complementary and alternative therapies should discuss this decision with their doctor, nurse, or pharmacist as they would any therapeutic approach, because some complementary and alternative therapies may interfere with their standard treatment or may be harmful when used with conventional treatment.
Evaluation of CAM Approaches
It is important that the same rigorous scientific evaluation used to assess conventional approaches be used to evaluate CAM therapies. The National Cancer Institute (NCI) and the National Center for Complementary and Alternative Medicine (NCCAM) are sponsoring a number of clinical trials (research studies) at medical centers to evaluate CAM therapies for cancer.
Conventional approaches to cancer treatment have generally been studied for safety and effectiveness through a rigorous scientific process that includes clinical trials with large numbers of patients. Less is known about the safety and effectiveness of complementary and alternative methods. Few CAM therapies have undergone rigorous evaluation. A small number of CAM therapies originally considered to be purely alternative approaches are finding a place in cancer treatment—not as cures, but as complementary therapies that may help patients feel better and recover faster. One example is acupuncture. According to a panel of experts at a National Institutes of Health (NIH) Consensus Conference in November 1997, acupuncture has been found to be effective in the management of chemotherapy-associated nausea and vomiting and in controlling pain associated with surgery. In contrast, some approaches, such as the use of laetrile, have been studied and found ineffective or potentially harmful.
The NCI Best Case Series Program, which was started in 1991, is one way CAM approaches that are being used in practice are being investigated. The program is overseen by the NCI’s Office of Cancer Complementary and Alternative Medicine (OCCAM). Health care professionals who offer alternative cancer therapies submit their patients’ medical records and related materials to OCCAM. OCCAM conducts a critical review of the materials and develops follow-up research strategies for approaches deemed to warrant NCI-initiated research.
Questions to Ask Your Health Care Provider About CAM
When considering complementary and alternative therapies, patients should ask their health care provider the following questions:
- What side effects can be expected?
- What are the risks associated with this therapy?
- Do the known benefits outweigh the risks?
- What benefits can be expected from this therapy?
- Will the therapy interfere with conventional treatment?
- Is this therapy part of a clinical trial?
- If so, who is sponsoring the trial?
- Will the therapy be covered by health insurance?
To Learn More About CAM
National Center for Complementary and Alternative Medicine (NCCAM)
The National Center for Complementary and Alternative Medicine (NCCAM) at the National Institutes of Health (NIH) facilitates research and evaluation of complementary and alternative practices, and provides information about a variety of approaches to health professionals and the public.
- NCCAM Clearinghouse
- Post Office Box 7923 Gaithersburg, MD 20898–7923
- Telephone: 1–888–644–6226 (toll free) 301–519–3153 (for International callers)
- TTY (for deaf and hard of hearing callers): 1–866–464–3615
- Fax: 1–866–464–3616
- E-mail: email@example.com
- Web site: http://nccam.nih.gov
CAM on PubMed
NCCAM and the NIH National Library of Medicine (NLM) jointly developed CAM on PubMed, a free and easy-to-use search tool for finding CAM-related journal citations. As a subset of the NLM's PubMed bibliographic database, CAM on PubMed features more than 230,000 references and abstracts for CAM-related articles from scientific journals. This database also provides links to the Web sites of over 1,800 journals, allowing users to view full-text articles. (A subscription or other fee may be required to access full-text articles.) CAM on PubMed is available through the NCCAM Web site. It can also be accessed through NLM PubMed bibliographic database by selecting the "Limits" tab and choosing "Complementary Medicine" as a subset.
Office of Cancer Complementary and Alternative Medicine
The NCI Office of Cancer Complementary and Alternative Medicine (OCCAM) coordinates the activities of the NCI in the area of complementary and alternative medicine (CAM). OCCAM supports CAM cancer research and provides information about cancer-related CAM to health providers and the general public via the NCI Web site.
National Cancer Institute (NCI) Cancer Information Service
U.S. residents may call the NCI Cancer Information Service toll free at 1-800-4-CANCER (1-800-422-6237) Monday through Friday from 8:00 am to 8:00 pm. A trained Cancer Information Specialist is available to answer your questions.
Food and Drug Administration
The Food and Drug Administration (FDA) regulates drugs and medical devices to ensure that they are safe and effective.
- Food and Drug Administration
- 5600 Fishers Lane
- Rockville, MD 20857
- Telephone: 1–888–463–6332 (toll free)
- Web site: http://www.fda.gov/
Federal Trade Commission
The Federal Trade Commission (FTC) enforces consumer protection laws. Publications available from the FTC include:
- Who Cares: Sources of Information About Health Care Products and Services
- Fraudulent Health Claims: Don’t Be Fooled
- Consumer Response Center
- Federal Trade Commission
- Washington, DC 20580
- Telephone: 1-877-FTC-HELP (1-877-382-4357) (toll free)
- TTY (for deaf and hearing impaired callers): 202-326-2502
- Web site: http://www.ftc.gov/
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
Images in the PDQ summaries are used with permission of the author(s), artist, and/or publisher for use within the PDQ summaries only. Permission to use images outside the context of PDQ information must be obtained from the owner(s) and cannot be granted by the National Cancer Institute. Information about using the illustrations in the PDQ summaries, along with many other cancer-related images, are available in Visuals Online, a collection of over 2,000 scientific images.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether one treatment is better than another. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients. During treatment clinical trials, information is collected about the effects of a new treatment and how well it works. If a clinical trial shows that a new treatment is better than one currently being used, the new treatment may become "standard." Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
This information was last updated on 2013-04-11