לחכמולוג של הפורום

שאלתי אותך שאלה פשוטה, לא ענית. לכל שאר הדברים ענית. זה מאוד מעניין. איפה המחקרים שאתה מדבר עליהם? לפטפט מפה עד ההודעה החדשה גם אני יודע, אבל כיסוי לדברים שלך - איין. איפה המחקרים? "ויש מחקרים המראים כי תוספים שונים עלולים לפגוע ביעילות של טיפולי כימותרפיה והקרנה." נו איפה המחקרים האלה? לא ראינו אפילו אחד.

: CA Cancer J Clin. 2005 Sep-Oct;55(5):319-21. Use of antioxidants during chemotherapy AND radiotherapy should be avoided. D'Andrea GM. Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY, USA. Many patients being treated for cancer use dietary supplements, particularly antioxidants, in the hope of reducing the toxicity of chemotherapy AND radiotherapy. Some researchers have claimed, furthermore, that antioxidants also increase the effectiveness of cytotoxic therapy AND have explicitly recommended their use. However, mechanistic considerations suggest that antioxidants might reduce the effects of conventional cytotoxic therapies. Preclinical data are currently inconclusive AND a limited number of clinical studies have not found any benefit. Clinicians should advise their patients against the use of antioxidant dietary supplements during chemotherapy OR radiotherapy. Such caution should be seen as the standard approach for any unproven agent that may be harmful. Clinical Evidence Even if the laboratory data were not conflicting AND confusing, they would be insufficient to guide clinical practice. There is no need here to recount the reasons why it is inappropriate to administer an agent to a cancer patient on the basis of cell culture studies AND why we require data from human clinical trials. But it is worth restating that the harmful effects of antioxidants might be important even if they were small: a reduction of only a few percentage points in the efficacy of chemotherapy might lead to hundreds OR thousands of deaths every year. Human trials therefore need to be large. There has been no attempt to mount the kind of trial needed to guide clinical practice, in which many hundreds of patients are randomized to receive chemotherapy OR radiotherapy with OR without antioxidants. Nonetheless, the clinical trial literature does provide some interesting data. The antioxidant perhaps most widely used for treating cancer is vitamin C. The possibility that this compound may be useful in the treatment of cancer was first raised by Cameron AND Campbell in 1974.20 Subsequently, Pauling AND Cameron published research suggesting a survival benefit from vitamin C.21 The use of historical controls AND the methods of patient selection weaken the level of evidence provided by this study. Subsequently, two randomized double-blind trials were conducted comparing placebo to vitamin C in patients with advanced cancers.22,23 Neither study was able to show any objective improvement in disease progression OR survival over placebo. Indeed, there seems to be somewhat worse survival in the vitamin C group. A study that more directly addresses the issue of antioxidant use concurrently with cytotoxics is that of Lesperance, et al.24 In this trial, 90 patients with early stage breast cancer who were prescribed megadoses of combination vitamins, minerals, AND other antioxidants concurrent with standard therapy were compared with 180 well-matched controls. Breast cancer–specific survival (P =.16) AND disease-free survival (P = 0.07) showed a trend toward worse survival in antioxidant-treated patients. Although many confounding factors may explain these differences in survival, the data should concern any oncologist who has patients considering antioxidant therapy. It should also be noted that several large prevention trials have reported clinical data showing no benefit for supplementation. In fact, there are reports that it may be detrimental. Two trials, the Alpha-Tocopherol Beta-Carotene Cancer Prevention Study (ATBCCPS)25 AND the Beta-Carotene AND Retinol Efficacy Trial (CARET),26 demonstrated an increased relative risk for developing lung cancer in the high-risk cohort receiving beta carotene supplementation. A meta-analysis of 14 randomized trials of antioxidant supplementation for the prevention of gastrointestinal cancers found no evidence that antioxidant supplements are effective. A subgroup analysis of higher quality trials suggested a small increase in mortality among people taking antioxidants compared with those in the placebo group.27 In the HOPE-TOO (Heart Outcomes Prevention Evaluation—The Ongoing Outcomes) trial, participants randomized to take either 400 IU of vitamin E daily OR a placebo did not differ significantly with regard to incidence of OR mortality from cancer overall OR cancers that previous studies suggested might be prevented by vitamin E (prostate, lung, oral, colorectal, breast, AND melanoma). However, people on vitamin E were more likely to develop heart failure.28 In another recent study, vitamin E had no effect on the incidence of second primary head AND neck tumors among survivors of Stage I OR II head AND neck cancer previously treated with radiotherapy.29 Although these chemoprevention trials are not directly applicable to the question of antioxidant use during treatment for active cancer, they do demonstrate that even though there was a plausible mechanism for antioxidant effect, good laboratory data, AND promising results from preliminary human studies, antioxidants were found to do more harm than good when tested in randomized trials. Taken together with treatment studies, these trials illustrate the complexity AND the contradictory nature of existing data. Further study is necessary to clarify the role of antioxidants.

נראה שיש לך בעיה בהבנת הניקרא של המאמר אותו אתה מביא כסימוכין המאמר מביא השערה בלבד המתבססת על mechanistic considerations אפילו לדעת המחבר אין במצב הנוכחי הוכחה חד משמעית שאנטי-אוקסידנטים מזיקים (או מועילים). יש הבדל גדול בן לא להאמין בפעולתם של אנטיאוקסידנטים, לבן להפחיד את המשתמשים ששימוש בהם עלול להזיק (נזק זניח ביחס לתופעות הלוואי של מרבית הטיפולים הכימוטרפיים)