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Three years later, another systematic review of all published randomized clinical trials was made public. This time, the aim of the investigators was to look at the existing evidence and come up with a conclusion regarding the influence of antioxidant supplementation on the efficacy of cancer chemotherapy. The main concern resided on the fact that certain chemotherapeutic agents acted by producing free radicals that destroy cancer cells and that antioxidants would, in fact, reduce the efficacy of these agents. In total, the results of 19 trials were considered.

From the 19 studies included in this review, no evidence was found that supported such concerns. Other relevant findings were made.
This enables increased or uninterrupted dosing in patients who otherwise may discontinue treatment due to side effects. Many of the trials summarized in this review also found survival and/or treatment response rates to be similar or higher in the antioxidant groups. However, the authors asks us to consider this information carefully as these trials were very diverse in terms of tumor and type of treatment, thus limiting the formulation of clear, definitive conclusions.
As mentioned above, this subject has raised interest among the scientific and patient communities and the controversy has not seized ever since. More recently, in 2013, yet another review was carried out to evaluate if, under the light of the newest evidence, antioxidants alter the efficacy of chemotherapy or not. The conclusions of this review were very similar to those of the review conducted in 2007.
Synthetic vs. natural antioxidants
The debate on the efficacy and safety of synthetic versus natural antioxidants is enduring. Natural antioxidants are primarily found in whole foods such as fruits, vegetables, and grains. Examples include vitamin C from citrus fruits and polyphenols from tea. In contrast, synthetic antioxidants are man-made, often formulated as supplements or used as food preservatives like butylated hydroxyanisole (BHA) and butylated hydroxytoluene (BHT).
Typically, natural antioxidants from whole foods are believed to be better absorbed by the body because they're combined with other beneficial compounds like fiber. On the other hand, the body might not efficiently recognize or absorb synthetic antioxidants.
There's also a risk associated with potency; synthetic antioxidants often have much higher potencies, which isn't always advantageous. In fact, high doses can be harmful, as seen with excessive intake of synthetic beta-carotene leading to increased lung cancer risk in smokers.
A significant distinction lies in the holistic benefits. Whole foods provide a blend of nutrients, fibers, and antioxidants that work synergistically, delivering health benefits that often stem from the combination of these compounds. In contrast, synthetic antioxidants, while consistent and stable, offer isolated compounds, missing the synergistic benefits of whole foods.
The extent of antioxidant benefits in cancer treatment remains unclear
Many of the studies indicate that antioxidant supplementation results in either increased survival times, increased tumor response, or both, as well as fewer toxicities than controls. In some of the last systematic reviews on this specific topic there is no evidence of antioxidant interference with chemotherapy mechanisms, with a possibility that antioxidants may even improve tumor response or patient survival. Nevertheless, data must be looked at with care. This evidence is highly limited by quality and sample size (number of patients in the trials).
See Also: A Delicate Balance of Antioxidants May Determine Recurrence of Breast Cancer
Until more is known about the effects of antioxidant supplements in cancer patients, these supplements should be used with caution. Cancer patients should inform their doctors about their use of any dietary supplement.
- FUCHS-TARLOVSKY, V. 2013. Role of antioxidants in cancer therapy. Nutrition, 29, 15–21
- LADAS, E. J., JACOBSON, J. S., KENNEDY, D. D., TEEL, K., FLEISCHAUER, A. & KELLY, K. M. 2004. Antioxidants and Cancer Therapy: A Systematic Review. Journal of Clinical Oncology, 22, 517-528
- BLOCK KI, KOCH AC, MEAD MN, TOTHY PK, NEWMAN RA & GYLLENHAAL C 2007. Impact of antioxidant supplementation on chemotherapeutic efficacy: A systematic review of the evidence from randomized controlled trials. Cancer Treatment Reviews, 33, 407-418.
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