Early Ascorbate-Only Trials
In the early 1970s, a consecutive case series was conducted in which 50 advanced-cancer patients were treated with large doses of ascorbic acid. These patients began ascorbic acid treatment after conventional therapies were deemed unlikely to be effective. Patients received intravenous (IV) ascorbic acid (10 g /day for 10 consecutive days; some patients received higher doses), oral ascorbic acid (10 g/day), or both. The subjects exhibited a wide variety of responses to treatment, including no or minimal response, tumor regression, and tumor hemorrhage. However, the authors noted that lack of controls prevented definitive assignment of any beneficial responses to the ascorbic acid treatment. A case report published in 1975 detailed one of the patients who had experienced tumor regression. Diagnosed with reticulum cell sarcoma, the patient exhibited improvement in well-being and resolution of lung masses after being treated with ascorbic acid. When the patient's daily dose of ascorbic acid was reduced, some of signs of the disease returned; however, remission was achieved again after the patient reverted to the higher initial dose.
A larger case series of terminal cancer patients treated with ascorbate was reported in 1976. In this study, 100 terminal cancer patients (50 of whom were reported on previously)  were treated with ascorbate (10 g/day for 10 days IV, then orally) and compared with 1,000 matched controls from the same hospital. The mean survival time for ascorbate-treated patients was 300 days longer than that of the matched controls.[3,4]
Two studies tried to reproduce earlier results. These studies were randomized, placebo-controlled trials in which cancer patients received either 10 g oral vitamin C or placebo daily until signs of cancer progression. At the end of each study, no significant differences were noted between the two ascorbate-treated and placebo-treated groups for symptoms, performance status, or survival.[5,6]Recent Ascorbate-Only Trials
One study reported three case reports of cancer patients who received IV vitamin C as their main therapy. During vitamin C therapy, the patients used additional treatments, including vitamins, minerals, and botanicals. According to the authors, the cases were reviewed in accordance with the NCI Best Case Series guidelines. Histopathologic examination suggested poor prognoses for these patients, but they had long survival times after being treated with IV vitamin C. Vitamin C was given at doses ranging from 15 g to 65 g, initially once or twice a week for several months; two patients then received it less frequently for 1 to 4 years.
Studies have shown that vitamin C can be safely administered to healthy volunteers or cancer patients at doses up to 1.5 g/kg and with screening to eliminate treating individuals with risk factors for toxicity (e.g., glucose-6-phosphate dehydrogenase deficiency, renal diseases, or urolithiasis). These studies have also found that plasma concentrations of vitamin C are higher with IV administration than with oral administration and are maintained for more than 4 hours.[10,11]Ascorbate-Combination Trials
A phase I study published in 2012 examined the safety and efficacy of combining IV ascorbate with gemcitabine and erlotinib in stage IV pancreatic cancer patients. Fourteen subjects entered the study and planned to receive IV gemcitabine (1,000 mg /m2 over 30 minutes, once a week for 7 weeks), oral erlotinib (100 mg daily for 8 weeks), and IV ascorbate (50 g/infusion, 75 g/infusion, or 100 g/infusion 3 times per week for 8 weeks). Minimal adverse effects were reported for ascorbic acid treatment. Five subjects received fewer than 18 of the planned 24 ascorbate infusions and thus did not have follow-up imaging to assess response. Three of those patients had clinically determined progressive disease. All of the other nine patients had repeat imaging to assess tumor size, and each met the criteria for having stable disease.
A 2013 phase I clinical study evaluated the safety of combining pharmacological ascorbate with gemcitabine in treating stage IV pancreatic cancer patients. During each 4-week cycle, patients received gemcitabine weekly for 3 weeks (1,000 mg/m2 over 30 minutes) and twice weekly ascorbate infusions for 4 weeks (15 g over 30 minutes during the first week, followed by weekly escalations in dose until plasma levels reached at least 350 mg/dL [20 mM]). Among nine patients, mean progression-free survival was 26 weeks and overall survival was 12 months. The combination treatment was well tolerated, and no significant adverse events were reported.
In 2014, a phase I/IIA clinical trial evaluated the toxicities of combining IV ascorbate with carboplatin and paclitaxel in stage III /IV ovarian cancer. Twenty-seven patients were randomly assigned to receive either chemotherapy alone or chemotherapy and IV vitamin C concurrently. Chemotherapy was given for 6 months, and IV vitamin C was given for 12 months. The addition of IV vitamin C was associated with reduced chemotherapy-related toxicities.
Trials of high-dose IV vitamin C with other drugs are ongoing.[12,14] A number of studies have included IV ascorbic acid treatment (1,000 mg) with arsenic trioxide regimens, with mixed results. The combination therapies were well tolerated and suggested beneficial effects in multiple myeloma patients, although the specific contribution of vitamin C could not be determined.[15-18] However, similar combination regimens resulted in severe side effects and disease progression in patients with acute myeloid leukemia, refractory metastatic colorectal cancer, and metastatic melanoma.Current Clinical Trials
Check NCI’s list of cancer clinical trials for cancer CAM clinical trials on ascorbic acid that are actively enrolling patients.
General information about clinical trials is also available from the NCI Web site.References
- Cameron E, Campbell A: The orthomolecular treatment of cancer. II. Clinical trial of high-dose ascorbic acid supplements in advanced human cancer. Chem Biol Interact 9 (4): 285-315, 1974. [PUBMED Abstract]
- Cameron E, Campbell A, Jack T: The orthomolecular treatment of cancer. III. Reticulum cell sarcoma: double complete regression induced by high-dose ascorbic acid therapy. Chem Biol Interact 11 (5): 387-93, 1975. [PUBMED Abstract]
- Cameron E, Pauling L: Supplemental ascorbate in the supportive treatment of cancer: Prolongation of survival times in terminal human cancer. Proc Natl Acad Sci U S A 73 (10): 3685-9, 1976. [PUBMED Abstract]
- Cameron E, Pauling L: Supplemental ascorbate in the supportive treatment of cancer: reevaluation of prolongation of survival times in terminal human cancer. Proc Natl Acad Sci U S A 75 (9): 4538-42, 1978. [PUBMED Abstract]
- Creagan ET, Moertel CG, O'Fallon JR, et al.: Failure of high-dose vitamin C (ascorbic acid) therapy to benefit patients with advanced cancer. A controlled trial. N Engl J Med 301 (13): 687-90, 1979. [PUBMED Abstract]
- Moertel CG, Fleming TR, Creagan ET, et al.: High-dose vitamin C versus placebo in the treatment of patients with advanced cancer who have had no prior chemotherapy. A randomized double-blind comparison. N Engl J Med 312 (3): 137-41, 1985. [PUBMED Abstract]
- Padayatty SJ, Riordan HD, Hewitt SM, et al.: Intravenously administered vitamin C as cancer therapy: three cases. CMAJ 174 (7): 937-42, 2006. [PUBMED Abstract]
- Vollbracht C, Schneider B, Leendert V, et al.: Intravenous vitamin C administration improves quality of life in breast cancer patients during chemo-/radiotherapy and aftercare: results of a retrospective, multicentre, epidemiological cohort study in Germany. In Vivo 25 (6): 983-90, 2011 Nov-Dec. [PUBMED Abstract]
- Yeom CH, Jung GC, Song KJ: Changes of terminal cancer patients' health-related quality of life after high dose vitamin C administration. J Korean Med Sci 22 (1): 7-11, 2007. [PUBMED Abstract]
- Padayatty SJ, Sun H, Wang Y, et al.: Vitamin C pharmacokinetics: implications for oral and intravenous use. Ann Intern Med 140 (7): 533-7, 2004. [PUBMED Abstract]
- Hoffer LJ, Levine M, Assouline S, et al.: Phase I clinical trial of i.v. ascorbic acid in advanced malignancy. Ann Oncol 19 (11): 1969-74, 2008. [PUBMED Abstract]
- Monti DA, Mitchell E, Bazzan AJ, et al.: Phase I evaluation of intravenous ascorbic acid in combination with gemcitabine and erlotinib in patients with metastatic pancreatic cancer. PLoS One 7 (1): e29794, 2012. [PUBMED Abstract]
- Welsh JL, Wagner BA, van't Erve TJ, et al.: Pharmacological ascorbate with gemcitabine for the control of metastatic and node-positive pancreatic cancer (PACMAN): results from a phase I clinical trial. Cancer Chemother Pharmacol 71 (3): 765-75, 2013. [PUBMED Abstract]
- Ma Y, Chapman J, Levine M, et al.: High-dose parenteral ascorbate enhanced chemosensitivity of ovarian cancer and reduced toxicity of chemotherapy. Sci Transl Med 6 (222): 222ra18, 2014. [PUBMED Abstract]
- Abou-Jawde RM, Reed J, Kelly M, et al.: Efficacy and safety results with the combination therapy of arsenic trioxide, dexamethasone, and ascorbic acid in multiple myeloma patients: a phase 2 trial. Med Oncol 23 (2): 263-72, 2006. [PUBMED Abstract]
- Berenson JR, Matous J, Swift RA, et al.: A phase I/II study of arsenic trioxide/bortezomib/ascorbic acid combination therapy for the treatment of relapsed or refractory multiple myeloma. Clin Cancer Res 13 (6): 1762-8, 2007. [PUBMED Abstract]
- Qazilbash MH, Saliba RM, Nieto Y, et al.: Arsenic trioxide with ascorbic acid and high-dose melphalan: results of a phase II randomized trial. Biol Blood Marrow Transplant 14 (12): 1401-7, 2008. [PUBMED Abstract]
- Berenson JR, Boccia R, Siegel D, et al.: Efficacy and safety of melphalan, arsenic trioxide and ascorbic acid combination therapy in patients with relapsed or refractory multiple myeloma: a prospective, multicentre, phase II, single-arm study. Br J Haematol 135 (2): 174-83, 2006. [PUBMED Abstract]
- Welch JS, Klco JM, Gao F, et al.: Combination decitabine, arsenic trioxide, and ascorbic acid for the treatment of myelodysplastic syndrome and acute myeloid leukemia: a phase I study. Am J Hematol 86 (9): 796-800, 2011. [PUBMED Abstract]
- Subbarayan PR, Lima M, Ardalan B: Arsenic trioxide/ascorbic acid therapy in patients with refractory metastatic colorectal carcinoma: a clinical experience. Acta Oncol 46 (4): 557-61, 2007. [PUBMED Abstract]
- Bael TE, Peterson BL, Gollob JA: Phase II trial of arsenic trioxide and ascorbic acid with temozolomide in patients with metastatic melanoma with or without central nervous system metastases. Melanoma Res 18 (2): 147-51, 2008. [PUBMED Abstract]