Zusammenfassung
Viele Patienten mit Krebs nehmen bei der Behandlung Supplemente mit antioxidativen
Vitaminen ein, meist ohne Wissen der Ärzte. Am häufigsten werden die Vitamine-C- und
-E-Supplemente in der Werbung empfohlen. Als Begründung werden sowohl die Verhinderung
von toxischen Nebenwirkungen der Chemotherapie, die Verbesserung des Krankheitsverlaufs
sowie die Verlängerung der Lebenserwartung genannt. Eine New Yorker Onkologiegruppe
hat 2004 in einem systematischen Review von 52 bisher veröffentlichten Beobachtungs-
und Interventionsstudien die Ergebnisse zusammengestellt. Demnach sind die erwarteten
positiven Auswirkungen der Supplemente nicht eingetreten. Dieser Überblick kommt zu
dem gleichen Resultat wie die kürzlichen Warnungen zweier amerikanischer und einer
englischen medizinischen Organisation, die „die Beweise für die Empfehlung von Antioxidanzien
als ungenügend” bezeichnet haben. Ähnliche Vorschläge für die Prävention der Demenz
mit hohen Vitamin-E- und -C-Dosierungen sind in keiner Weise belegt. Die über 30 Jahre
laufende Honolulu-Asia-Aging-Studie hat 2004 an 2459 Männern gezeigt, dass die im
mittleren Lebensalter zugeführten Antioxidanzien keinen Einfluss auf die Entwicklung
von im späteren Lebensalter auftretender Demenz haben.
Abstract
Many patients with cancer take antioxidant nutritional supplements during their therapy
to alleviate treatment toxicities and to improve survival by preventing recurrence
rates. The vitamins most frequently advertised are C and E. A New York oncology group
in 2004 has reviewed 52 observational studies and intervention trials to measure the
influence of these vitamin supplements on their effectiveness in the treatment of
patients: Neither toxicity was prevented nor was there any extension of survival.
The inconsistencies found in several aspects of cancer therapy with antioxidants led
to similar conclusions as quoted from two American and one British medical organizations:
„There is at least fair evidence that Beta-Carotene is ineffective or that the harms
outweigh the benefits for prevention of cancer”. „The suggestion that antioxidant
supplements show benefits in cancer treatment has not been proved or consistently
supported by findings of intervention trials.” Similar recommendations for the prevention
of dementia with high doses of vitamins C and E are not substantiated by any evidence.
The longest (30 years) prospective community study of 2459 American-Japanese men concluded
in 2004 that dietary intake of antioxidants in midlife does not modify the risk of
late life dementia or the most prevalent subtypes.
Schlüsselwörter
Chemotherapie - Toxizität - Überleben - Antioxidanzien - Prävention - Krebs - Demenz
Key words
Chemotherapy - toxicity - survival - antioxidants - prevention - cancer - dementia
Literatur
- 1
Vivekananthan D P, Penn M S, Sapp S K, Hsu A, Topol E J.
Use of antioxidant vitamins for the prevention of cardiovascular disease: meta-analysis
of randomised trials.
Lancet.
2003;
361
2017-2023
- 2
Eidelman R S, Hollar D, Hebert P R, Lamas G A, Hennekens C H.
Randomised trials of vitamin E in the treatment and prevention of cardiovascular disease.
Arch Intern Med.
2004;
164
1552-1556
- 3
Heyden S.
Das Ende der Supplementierung mit antioxidativen Vitaminen.
Aktuel Ernaehr Med.
2003;
28
113-120
- 4
Lee D H, Folsom A R, Harnack L. et al .
Does supplemental vitamin C increase cardiovascular disease risk in women with diabetes?.
Am J Clin Nutr.
2004;
80
1194-1200
- 5
Ladas E J, Jacobson J S, Kennedy D D, Teel K, Fleischauer A, Kelly K M.
Antioxidants and cancer therapy; A systematic review.
J Clin Oncol.
2004;
22
517-528
- 6
Kumar N B, Hopkins K, Allen K, Riccardi D, Besterman-Dahan K, Moyers S.
Use of complementary/integrative nutritional therapies during cancer treatment: Implications
in clinical practice.
Cancer Control.
2002;
9
236-243
- 7
Weijil N I, Eisendorn T J, Lentjen E GWM. et al .
Supplementation with antioxidant micronutrients and chemotherapy-induced toxicity
in cancer patients treated with cisplatin-based chemotherapy: a randomised, double-blind,
placebo-controlled study.
Europ J Cancer.
2004;
40
1713-1723
- 8
US Preventive Services Task Force .
Routine vitamin supplementation to prevent cancer and cardiovascular disease: recommendations
and rationale.
Ann Intern Med.
2003;
139
51-55
- 9
Kline K, Lawson K A, Yu W P, Sanders B G.
National Academy of Sciences Food and Nutrition Board. Vitamin E and breast cancer
prevention: Current status and future potential.
J Mammary Gland Biol Neopl.
2003;
8
91-102
- 10
Hirose K, Takezaki T, Hamajima N, Miura S, Tajima K.
Dietary factors protective against breast cancer in japanese premenopausal and postmenopausal
women.
Internat J Cancer.
2003;
107
276-282
- 11
The Alpha-Tocopherol, Beta Carotene Cancer Prevention Study Group .
The effect of vitamin E and beta carotene on the incidence of lung cancer and other
cancers in male smokers.
N Engl J Med.
1994;
330
1029-1035
- 12
Rodriguez C, Jacobs E J, Mondul A M, Calle E E, McCullough M L, Thun M J.
Vitamin E supplements and risk of prostate cancer in US men.
Cancer Epidem Biomark Prev.
2004;
13
378-382
- 13
Rautalahti M T, Virtamo J R, Taylor P R. et al .
The effects of supplementation with alpha-tocopherol and beta-carotene on the incidence
and mortality of carcinoma of the pancreas in a randomized, controlled trial.
Cancer.
1999;
86
37-42
- 14
Malila N, Taylor P R, Virtanen M J. et al .
Effects of alpha-tocopherol and beta-carotene supplementation on gastric cancer incidence
in male smokers (ATBC Study, Finland).
Cancer Caus Contr.
2002;
13
617-623
- 15
Stanner S A, Hughes J, Kelly C N, Buttriss J.
British Nutrition Foundation. A review of the epidemiological evidence for the „antioxidant
hypothesis”.
Publ Hlth Nutr.
2004;
7
407-422
- 16
Stampfer M J, Hu F B, Manson J AE, Rimm E B, Willett W C.
Primary prevention of coronary heart disease in women through diet and lifestyle.
N Engl J Med.
2000;
343
16-22
- 17
Omenn G S, Goodman G E, Thornquist M D. et al .
Effects of a combination of the beta-carotene and vitamin A on lung cancer and cardiovacular
desease.
N Engl J Med.
1996;
334
1150-1155
- 18
Hennekens C H, Buring J E, Manson J E, Stampfer N. et al .
Lack of effect of long-time supplementation with beta-carotene on the incidence of
malignant neoplasms and cardiovascular disease.
N Engl J Med.
1996;
334
1145-1149
- 19
Laurin D, Masaki K H, Foley D J, White L R, Launer L J.
Midlife dietary intake of antioxidants and risk of late-life incident dementia - The
Honolulu-Asia Aging Study.
Am J Epidem.
2004;
159
959-967
- 20
Pettenati C, Vegliante M B, Perotta D.
La viamina E nella prevenzione dell' Alzheimer e delle malattie neurodegenerative.
Medico e paziente.
2003;
4 supplemente
1-6
- 21 Miller E R, Pastor-Barriuso R, Dalal D, Riemersma R A, Appel L J, Guallar E. Meta-analysis:
High dosage vitamin E supplements may increase all-cause mortality. Referat am Kongress,
American Heart Association 10.11.04 (New Orleans, Louisiana). Ann Intern Med 2005,
im Druck
- 22
Bjelakovic G, Nikolova D, Simonetti R G, Gluud C.
Antioxidant supplements for prevention of gastrointestinal cancers. A systematic review
and meta-analysis.
Lancet.
2004;
364
1219-1228
Prof. Dr. med. Siegfried Heyden
6575 San Nazzaro · Schweiz
oder 2729 Montgomery Str.
Durham N.C. 27705 · USA
