
Vitamin C and Immuno-Oncology - daddylonglegs
https://blogs.sciencemag.org/pipeline/archives/2020/03/02/vitamin-c-and-immuno-oncology
======
pazimzadeh
Here's the original article:

High-dose vitamin C enhances cancer immunotherapy
[https://stm.sciencemag.org/content/12/532/eaay8707/](https://stm.sciencemag.org/content/12/532/eaay8707/)

Takeaways:

Oral Vitamin C and intravenous Vitamin C have vastly different
pharmacokinetics and effects on cancer.

\- Low dose vitamin C (oral) is anti-oxidant and may attenuate chemotherapy:

Chemosensitizing effect of vitamin C in combination with 5-fluorouracil in
vitro
[https://www.ncbi.nlm.nih.gov/pubmed/12929582](https://www.ncbi.nlm.nih.gov/pubmed/12929582)
"only a high concentration of vitamin C increased the cytotoxicity of 5-FU"

Ascorbic acid attenuates antineoplastic drug 5-fluorouracil induced
gastrointestinal toxicity in rats by modulating the expression of inflammatory
mediators
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5598240/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5598240/)

\- High dose vitamin C (intravenous) is pro-oxidant

\- High dose vitamin C (intravenous) alone slows tumor growth

\- High dose vitamin C (intravenous) combined with immunotherapy has a
synergistic effect

High dose vitamin C (intravenous) also synergizes with chemotherapy and spares
healthy cells
[https://stm.sciencemag.org/content/6/222/222ra18](https://stm.sciencemag.org/content/6/222/222ra18)

If you are in chemotherapy or immunotherapy, stay away from low doses of oral
anti-oxidant supplements such as Vitamin C.

~~~
tomlue
We did a data extraction project for 81 trials using oral or intravenous IV as
a cancer therapy! You can see the whole project at
[https://sysrev.com/p/6737](https://sysrev.com/p/6737). Basically we imported
81 VitC trials from clinicaltrials.gov and extracted dose levels,
administration methods, placebo usage, and some other data.

You can see all the oral studies here:
[https://shorturl.at/mvxy4](https://shorturl.at/mvxy4)

You can see all the IV studies here:
[https://shorturl.at/bn019](https://shorturl.at/bn019)

The results of the research will be published soon...

~~~
tomlue
Those links are broken and should be

You can see all the oral studies here:
[https://bit.ly/3ct2q4u](https://bit.ly/3ct2q4u)

You can see all the IV studies here:
[https://bit.ly/2Th9ud5](https://bit.ly/2Th9ud5)

------
y0ssar1an
Don't waste my time with this stuff.

    
    
      - single study
      - on mice
      - hasn't been replicated
      - purely speculative mechanism of action (How exactly is Vitamin C helping? They don't know!)
    

I guess I have to remind everyone that most published research is false:
[https://journals.plos.org/plosmedicine/article?id=10.1371/jo...](https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.0020124)

~~~
ksaun
I appreciate and believe I understand your perspective. I do not refute your
criticisms of the research.

I have a different perspective, however. As someone who is expected to die of
cancer within a few years, even early/flawed research is of interest.
Especially with the cognitive impairments I feel from chemotherapy, I find it
challenging to wade through all of the ideas and opinions to get to
information that's useful in guiding decisions about my treatment.

In particular, this thread acquainted me with jcims's life experiences. I take
his statements at face value and believe that he's indeed spent countless
hours researching various treatment possibilities. That he is left with the
belief that vitamin C has promise as a treatment option gives me cause to
further explore the relevant science. I lack the time, energy, and knowledge
to investigate the plethora of options/speculation, so I greatly appreciate
when another credible person points me in a direction that's worthy of greater
attention.

This doesn't mean I'm planning to ask my oncologist about vitamin C or pursue
this as a treatment option at this time. :) It just gives me a promising area
of further exploration and I'll see where it leads me.

From this thread, I also gained reinforcement (in part through pazimzadeh's
summary, below) of my understanding that taking vitamin C oral supplements
during chemotherapy is ill-advised. I'd come across this guidance before, but
have been reminded of it by this article and this discussion.

So, my request to you is to please not discourage posts such as this article
here on Hacker News. If you prefer to not have your "time wasted [by] this
stuff" then please don't click on such articles or please suffer in silence.
Or, better yet, post your summary of the research's limitations, as you've
done here. (That is, your summary is useful, but your first line saddened me,
as I appreciated having my time "wasted" by this article and the subsequent
discussion. I hope others here do not heed your request.)

Edit: minor editing to simplify. (I realize this post is still rather wordy,
please forgive.)

~~~
wysifnwyg
They're encouraging the scientific process, which is the method by which we
validate science. Your objections to scientific process only serves to detract
from that process.

~~~
ksaun
What aspect(s) of my post suggest that I object to scientific process? (I do
not believe myself to hold the opinion you're attributing to me.)

------
jcims
Pursuing this as an adjunct therapy for my wife's cancer treatment showed me a
side of healthcare that I hadn't really considered before. Fear. Not fear of a
calculated risk going the wrong way healthwise, but profound fear of stepping
anywhere outside the brightly lit path of 'standard of care'. There's this
phase change in the doctor's expression that you can see visually when you
enter into conversations such as this (the other one being management of
hyperglycemia). There's a certain slackening of facial expression and
straightening of posture. The vocabulary becomes smaller, blinking more
regular, tone flatter and the conversation becomes more circular.

It took me a little while to sort it out, but I've come to the conclusion that
these (mostly young) doctors are so incredibly leveraged in their position by
student loans and sunk cost into their education that they simply cannot risk
anything outside of the prescribed approach to care for a
patient...particularly one where there is generally a foregone conclusion as
to the outcome. I initially raged against them individually, but now I see
them as scared children and my hatred is directed towards the system that
creates this fear. Should I encounter this situation again, my first goal will
be to find a doctor with a terminal illness themselves and see if we can't
forge a new path together.

~~~
arkades
Living on the other side of that table, and living in the rooms where docs sit
and shoot the shit after such patient encounters, _and_ as someone with a
debilitating chronic illness that people love to spout bullshit alternative
medicine theories and treatments for, I'm going to go ahead and say your
conclusion is both self-serving and wrong.

Self-serving because, naturally, the reason that your requests are met with
poor regard isn't because there's something wrong with the request, but
because something is wrong with the person receiving it. But that's okay;
that's the nature of human opinion and subjectivity. You can accuse me of the
same, of course - oh, and will. I'm sure this thread will go from Zero to
Malpractice in 6.4 seconds.

But wrong:

You're going to ignore this sentence, but dear god, do I want to burn it into
your eyeballs, and the eyeballs of every person reading this: _I care_. The
vast majority of my colleagues _care_. The vast majority of nurses _care_. The
vast majority of everyone you meet in the hospital _cares_. They've been
there, either themselves, or with a loved one; have been there in the past, or
are there _now_ , whether or not they disclose that to you. They _give a
shit_.

When we work with someone that is suffering and dying, _we care_. We hurt. And
when, god help us, there's a chance we can actually help and reduce that
suffering, be it for the patient or their family, and they _take that away
from us_ , we hate them a little. We hate them for making us care, and making
us watch and experience and share this suffering when maybe we didn't have to.

When a patient says, "You know, it's really important to us that we explore
(dubious option X)", it puts up our radar for "oh fuck, this is going to
suck." And the more the patient goes down that road, the more we know they're
going to veer away from care that's _at least have some evidentiary basis to
support it working_ , the more we know we have to go down the fucking drain
with them.

Not that long ago we had a lady on our IM service who'd had a promptly
diagnosed, treatable, resectable local cancer... 18 months ago. 18 months of
quack bullshit later, she came in to us because of the severity of her
constipation, because that cancer arose near her intestines, and had now
matted and infiltrated them. She and her family were proof to all
conversations regarding reality: she just needed IV nutrition of the
appropriate sort, because the problem wasn't that the cancer had utterly
invaded her GI tract, it was that she needed the right vitamins! Our
nutritionist couldn't come up with the miracle combination of IV nutrition for
her, because she kept deteriorating (of course she did.) The family wouldn't
allow painkillers, because those worsen constipation, and of course, they
refused to acknowledge this constipation was because of her rampant cancer
they opted to leave untreated, not because of some magic nutritional
deficiency. Which means no opiates - because any minute now we're going to
cure that constipation with the magic vitamin.

So we had to listen to her scream, then moan, then quietly writhe. For days.
While the family insisted we just find the right vitamin. Until the family
insisted we try spoon-feeding her, because there just isn't the right IV feed
for her. We refused. They fed her themselves. This lady who hasn't passed
stool in two-odd weeks promptly vomited, aspirated, and within a few hours was
in the ICU for a chemical pneumonitis.

We got to watch her die. We got to visit every-day. We got to try to gladhand
the family and give them bland cliches because we didn't want them to hurt
more. We didn't want to rub it in that they killed their mother.

But we got to watch it. In detail. I had the dismal, terrible pleasure of
pronouncing her dead.

I'm not afraid of the terribly scary management of a vitamin C infusion in a
terminal patient. I'm hurt. I'm pained. I suffer every time I have to watch
preventable misery and death because a patient and/or their loved one's are
busy chasing Google MD's endless font of nonsense. And because I'm not a
goddamned robot, I dislike suffering, and those people that force me through
more.

Surprisingly, doctors take a lot of solace in "we did what we could for her.
We made it as painless as possible. We gave her as many days as we could."
That means a lot. And when it's taken away from us, holy shit, do we hate it.

This was pretty stream-of-consciousness. I'm not editing it, and I'm not
coming back to it, so if anyone bothers responding, know it's not for me.

~~~
wavepruner
Thanks for this. As a chronically ill patient I've spent years struggling to
understand why doctors get so uncomfortable and sometimes hostile when I
pursue experimental treatments. Knowing that you go through the devastation of
watching people do reckless and dangerous things helps me understand.

------
clumsysmurf
I found this summary to be an easier read than the original research paper

[https://medicalxpress.com/news/2020-02-high-doses-vitamin-
im...](https://medicalxpress.com/news/2020-02-high-doses-vitamin-
immunotherapy-combating.html)

------
chrisco255
Worth noting that clinical trials are underway for studying the effect of
vitamin C infusions on 2019-nCov:

[https://clinicaltrials.gov/ct2/show/NCT04264533](https://clinicaltrials.gov/ct2/show/NCT04264533)

------
bastian
This is an interesting link from the comments section of the article:
[https://clinicaltrials.gov/ct2/show/NCT04264533](https://clinicaltrials.gov/ct2/show/NCT04264533)

------
watertom
Mice do not equal Humans for one simple fact.

Mice produce l-Ascoribic Acid already, where humans cannot.

I would argue that guinea pigs would be a much better model, because guinea
pigs, like humans don't manufacture their own vitamin C.

I would argue that testing any vitamin C therapy on animals that product their
own l-ascorbic acid is a waste of time.

------
piinthesky
Timing is everything when money is involved.
[https://www.dailymail.co.uk/health/article-8067189/Chinas-
do...](https://www.dailymail.co.uk/health/article-8067189/Chinas-doctors-
racing-Vitamin-C-beat-coronavirus.html)

------
pstuart
Shooting up C doesn't sound appealing, but I wonder if liposomal C might be
worth exploring after all.

------
kaikai
Very high doses of vitamin C are also an abortifacient, although it's not as
reliable as other medical methods. If you think you might be pregnant or are
trying to become pregnant think twice about using vitamin C to treat another
other conditions.

------
blackrock
ELI5 please. So billions of dollars spent on cancer research, and the solution
this entire time, is to simply spike the IV drip with some lemon juice?

------
1996
TLDR: A team of researchers affiliated with multiple institutions in Italy has
found that giving cancerous mice high doses of vitamin C (ascorbic acid)
enhanced immunotherapy, resulting in slowed or stopped tumor growth.

Maybe Linus Pauling was indeed on to something
([https://en.wikipedia.org/wiki/Linus_Pauling](https://en.wikipedia.org/wiki/Linus_Pauling)
) with his idea of high dose IV vitamin C: skipping the article as it seems to
take political positions ("But if this work makes some headlines of the “Linus
Pauling was right” sort, don’t believe them") and using Wikipedia as a source
instead:

Pauling's work on vitamin C in his later years generated much controversy. He
was first introduced to the concept of high-dose vitamin C by biochemist Irwin
Stone in 1966. After becoming convinced of its worth, Pauling took 3 grams of
vitamin C every day to prevent colds.[13] Excited by his own perceived
results, he researched the clinical literature and published Vitamin C and the
Common Cold in 1970. He began a long clinical collaboration with the British
cancer surgeon Ewan Cameron in 1971 on the use of intravenous and oral vitamin
C as cancer therapy for terminal patients.[143] Cameron and Pauling wrote many
technical papers and a popular book, Cancer and Vitamin C, that discussed
their observations. Pauling made vitamin C popular with the public[144] and
eventually published two studies of a group of 100 allegedly terminal patients
that claimed vitamin C increased survival by as much as four times compared to
untreated patients

(...)

medical establishment concluded that his claims that vitamin C could prevent
colds or treat cancer were quackery.[13][151] Pauling denounced the
conclusions of these studies and handling of the final study as "fraud and
deliberate misrepresentation",[152][153] and criticized the studies for using
oral, rather than intravenous vitamin C[154] (which was the dosing method used
for the first ten days of Pauling's original study

~~~
SAI_Peregrinus
I wouldn't say that "But if this work makes some headlines of the “Linus
Pauling was right” sort, don’t believe them" is a political position. Pauling
was wrong: he didn't say "High dose IV vitamin C is helpful", he said
(paraphrased) "High dose IV vitamin C is helpful because it is an
antioxidant". But it's not an antioxidant, as this paper shows, it's an
oxidant! It's helpful, but for exactly the wrong reason, and low-dose vitamin
C _is_ an antioxidant, which is _harmful_! So if Pauling were correct you'd
expect other antioxidants to help, but they also cause harm (in oncology).

~~~
1996
So basically this guy who said vitamin C IV in high doses fights cancer was
wrong and should be never rehabilitated , because the hypothetised mechanism
was the other way around? (anti oxidant -> oxidant)

I think we are forgetting the most important result there: vitamin C IV in
high doses fights cancer.

~~~
SAI_Peregrinus
> I think we are forgetting the most important result there: vitamin C IV in
> high doses fights cancer.

No, that's wrong. Vitamin C IV in high doses _makes certain chemotherapy work
better_ to fight cancer. And does so in a way that Pauling wouldn't have been
able to predict, his mechanism of action would imply that it would reduce the
effectiveness of the chemotherapy.

------
KWxIUElW8Xt0tD9
look up papers by Dr. Klenner on the use of intravenous vitamin C

see also "living proof" a New Zealand 60-minutes segment

