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Vitamin C improves Decitabine response in Acute Myeloid Leukemia patients

Oct 4, 2019

Highlights

A recent study done in China on elderly Acute Myeloid Leukemia (AML) patients showed that Vitamin C supplementation/infusion increased the responsiveness of the hypomethylating drug Decitabine (Dacogen) from 44% to 80% in these cancer patients. Hence, combination of a higher dose of Vitamin C and/or a diet rich in Vitamin C with Decitabine can be a good option for improving response rates for elderly Leukemia (AML) patients.



Vitamin C / Ascorbic Acid

Vitamin C is a strong antioxidant and an excellent immunity booster. It is also known as ascorbic acid. Vitamin C is an essential vitamin, and is hence obtained through a healthy diet. Vitamin C is abundantly found in many fruits and vegetables. Lack of intake of Vitamin C may result in Vitamin-C deficiency called scurvy.

Food Sources of Vitamin C

Following are some of the foods rich in Vitamin C : 

  • Citrus fruits such as oranges, lemons, grapefruits, pomelos, and limes. 
  • Guava
  • Green peppers
  • Red peppers
  • Strawberries
  • Kiwi fruit
  • Papaya
  • Pineapple
  • Tomato juice
  • Potatoes
  • Broccoli
  • Cantaloupes
  • Red cabbage
  • Spinach

Acute Myeloid Leukemia (AML) and Decitabine/Dacogen

There are specific chemo drugs used for different cancer indications. Decitabine/Dacogen is one such chemo drug used to treat acute myeloid leukemia (AML), a rare but critical cancer of the blood and bone marrow. Leukemia causes the white blood cells to grow rapidly and abnormally, and they crowd out other types of blood cells such as the red blood cells that carry oxygen and platelets that help with clotting the blood. Even the abnormal white blood cells cannot do their normal job of fighting infection and their abnormal increase starts to affect other organs. ‘Acute AML’ describes the fast growing nature of this cancer type. Hence this condition progresses rapidly and has poor outcomes with median survival of just one year (Klepin HD, Clin Geriatr Med. 2016).

Vitamin-C for Acute Myeloid Leukemia - diet good for Decitabine response

One of the underlying causes for the development of cancers in general and leukemias in particular is that the defense, error-correction mechanisms within the cell, under the control of tumor suppressor genes in the DNA, are turned off through a modification switch called methylation. This methylation switch is used in nature to imprint specialized memory of what genes and functions to turn on or off in different stages of growth of cells performing specialized functions. Cancer cells co-opt this methylation switch and use it excessively to turn off the tumor suppressor genes which allow them to continue replicating unchecked and unrestrained.

Vitamin C improves Decitabine Response in Leukemia Patients

One of the chemotherapy for AML is a class of drugs called ‘hypomethylating agents’ HMA that inhibit this methylation switch to enable the re-activation of the tumor suppressor genes to control the leukemia. Decitabine is one of the HMA drugs used for AML. The HMA drugs are used for the more elderly AML patients who are above 65 years and cannot withstand the more aggressive chemotherapy treatment conventionally used for AML. The response rates for these drugs is generally low, only about 35-45% (Welch JS et al, New Engl J Med. 2016). A recent study done in China, tested the impact of administering Vitamin C infusions with Decitabine on elderly cancer patients with Acute Myeloid Leukemia between a cohort that only took Decitabine and another cohort that took Decitabine and Vitamin C. Their results showed that Vitamin C infusion did indeed have a synergistic effect with Decitabine as the AML cancer patients who took the combination therapy had a higher complete remission rate of 79.92 % versus the 44.11 % in those who did not have the Vitamin C supplementation (Zhao H et al, Leuk Res. 2018). The scientific rationale for how Vitamin C improved the Decitabine response was determined and it was not just a random chance effect. A diet rich in Vitamin C may be good for improving treatment response in Leukemia patients treated with Decitabine.

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Conclusion

While Vitamin C is consumed generally as part of a balanced diet, this study has shown that the combination of a slightly higher dose of Vitamin C along with Decitabine can be a life changer for elderly patients with Acute Myeloid Leukemia. Vitamin C can be found naturally in citrus fruits and a variety of greens such as spinach and lettuce or obtained from Vitamin supplements that can be bought over the counter. Including Vitamin C as part of the diet may benefit leukemia patients by improving the therapeutic (Decitabine) response. This highlights that scientifically chosen natural products can complement chemotherapy to improve the odds of success and well being of the patient.


Cancer patients often have to deal with different chemotherapy side effects which affect their quality of life and look out for alternative therapies for cancer. Taking the right nutrition and supplements based on scientific considerations (avoiding guesswork and random selection) is the best natural remedy for cancer and treatment related side-effects.


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