Med. praxi. 2024;21(5):306-313 | DOI: 10.36290/med.2024.033

Critical evaluation of intravenous vitamin C in practice

PharmDr. Marek Lapka, Ph.D.
Ústav farmakologie 3. LF UK, Praha

Vitamin C is important as a reducing agent and is involved in many biological processes, including collagen and neurotransmitter synthesis. This study aimed to critically review the available information on the potential of intravenous vitamin C (IVC) in oncology and to discuss cases where its use might be indicated. A literature review of available scientific publications focusing on the use of IVC in the treatment of cancer was conducted. Papers from the last two decades were included, including phase I-III trials that evaluated the safety, tolerability, and efficacy of IVC. High-dose IVC has potential as an adjuvant therapy in oncology, particularly in combination with chemotherapy and radiotherapy. However, further large-scale trials are needed to confirm these findings and to define optimal dosages and schedules in specific indications.

Keywords: vitamin C, ascorbic acid, high dose, oncology, cancer.

Received: July 19, 2024; Revised: August 28, 2024; Accepted: September 4, 2024; Published: December 2, 2024  Show citation

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Lapka M. Critical evaluation of intravenous vitamin C in practice. Med. praxi. 2024;21(5):306-313. doi: 10.36290/med.2024.033.
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References

  1. Carpenter KJ. The history of scurvy and vitamin C (Transferred to digital printing). Cambridge Univ. Pr; 2003.
  2. Padayatty SJ, Levine M. Vitamin C: the known and the unknown and Goldilocks. Oral, DiS. 2016 Sep;22(6):463-93. doi: 10.1111/odi.12446. Epub 2016 Apr 14. PMID: 26808119; PMCID: PMC4959991. Go to original source... Go to PubMed...
  3. Rebouche CJ. Renal handling of carnitine in experimental vitamin C deficiency. Metabolism. 1995 Dec;44(12):1639-43. doi: 10.1016/0026-0495(95)90087-x. PMID: 8786736. Go to original source... Go to PubMed...
  4. Ronchetti IP, Quaglino D Jr, Bergamini G. Ascorbic acid and connective tissue. Subcell Biochem. 1996;25:249-64. doi: 10.1007/978-1-4613-0325-1_13. PMID: 8821978. Go to original source... Go to PubMed...
  5. Katsuki H. Vitamin C and nervous tissue. In vivo and in vitro aspects. Subcell Biochem. 1996;25:293-311. doi: 10.1007/978-1-4613-0325-1_15. PMID: 8821980. Go to original source... Go to PubMed...
  6. Horrobin DF. Ascorbic acid and prostaglandin synthesis. Subcell Biochem. 1996;25:109-15. doi: 10.1007/978-1-4613-0325-1_6. PMID: 8821971. Go to original source... Go to PubMed...
  7. Heller R, Münscher­‑Paulig F, Gräbner R, et al. L­‑Ascorbic acid potentiates nitric oxide synthesis in endothelial cells. J Biol Chem. 1999 Mar 19;274(12):8254-60. doi: 10.1074/jbc.274. 12. 8254. PMID: 10075731. Go to original source...
  8. Hemilä H, Chalker E. Vitamin C for preventing and treating the common cold. Cochrane Database Syst Rev. 2013 Jan 31;2013(1):CD000980. doi: 10.1002/14651858.CD000980.pub4. PMID: 23440782; PMCID: PMC8078152. Go to original source... Go to PubMed...
  9. Hemilä H, Chalker E. Vitamin C reduces the severity of common colds: a meta­‑analysis. BMC Public Health. 2023 Dec 11;23(1):2468. doi: 10.1186/s12889-023-17229-8. PMID: 38082300; PMCID: PMC10712193. Go to original source... Go to PubMed...
  10. Coulter ID, Hardy ML, Morton SC, et al. Antioxidants vitamin C and vitamin e for the prevention and treatment of cancer. J Gen Intern Med. 2006 Jul;21(7):735-44. doi: 10.1111/j.1525-1497.2006.00483.x. PMID: 16808775; PMCID: PMC1924689. Go to original source... Go to PubMed...
  11. Gaziano JM, Glynn RJ, Christen WG, et al. Vitamins E and C in the prevention of prostate and total cancer in men: the Physicians' Health Study II randomized controlled trial. JAMA. 2009 Jan 7;301(1):52-62. doi: 10.1001/jama.2008.862. Epub 2008 Dec 9. PMID: 19066368; PMCID: PMC2774210. Go to original source... Go to PubMed...
  12. Wang L, Sesso HD, Glynn RJ, et al. Vitamin E and C supplementation and risk of cancer in men: posttrial follow­‑up in the Physicians' Health Study II randomized trial. Am J Clin Nutr. 2014 Sep;100(3):915-23. doi: 10.3945/ajcn.114.085480. Epub 2014 Jul 9. PMID: 25008853; PMCID: PMC4135500. Go to original source... Go to PubMed...
  13. Lin J, Cook NR, Albert C, et al. Vitamins C and E and beta carotene supplementation and cancer risk: a randomized controlled trial. J Natl Cancer Inst. 2009 Jan 7;101(1):14-23. doi: 10.1093/jnci/djn438. Epub 2008 Dec 30. PMID: 19116389; PMCID: PMC2615459. Go to original source... Go to PubMed...
  14. 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. 2014 Feb 5;6(222):222ra18. doi: 10.1126/scitranslmed.3007154. PMID: 24500406. Go to original source... Go to PubMed...
  15. 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. 2012;7(1):e29794. doi: 10.1371/journal.pone.0029794. Epub 2012 Jan 17. PMID: 22272248; PMCID: PMC3260161. Go to original source... Go to PubMed...
  16. Ou J, Zhu X, Chen P, et al. A randomized phase II trial of best supportive care with or without hyperthermia and vitamin C for heavily pretreated, advanced, refractory non­‑small­‑cell lung cancer. J Adv Res. 2020 Mar 17;24:175-182. doi: 10.1016/j.jare.2020. 03. 004. PMID: 32368355; PMCID: PMC7190757. Go to original source...
  17. 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. 2013 Mar;71(3):765-75. doi: 10.1007/s00280-013-2070-8. Epub 2013 Feb 5. PMID: 23381814; PMCID: PMC3587047. Go to original source... Go to PubMed...
  18. Böttger F, Vallés­‑Martí A, Cahn L, et al. High­‑dose intravenous vitamin C, a promising multi­‑targeting agent in the treatment of cancer. J Exp Clin Cancer Res. 2021 Oct 30;40(1):343. doi: 10.1186/s13046-021-02134-y. PMID: 34717701; PMCID: PMC8557029. Go to original source... Go to PubMed...
  19. Doseděl M, Jirkovský E, Macáková K, et al. Vitamin C­‑Sources, Physiological Role, Kinetics, Deficiency, Use, Toxicity, and Determination. Nutrients. 2021 Feb 13;13(2):615. doi: 10.3390/nu13020615. PMID: 33668681; PMCID: PMC7918462. Go to original source... Go to PubMed...
  20. Isola S, Gammeri L, Furci F, et al. Vitamin C Supplementation in the Treatment of Autoimmune and Onco­‑Hematological Diseases: From Prophylaxis to Adjuvant Therapy. Int J Mol Sci. 2024 Jul 2;25(13):7284. doi: 10.3390/ijms25137284. PMID: 39000393; PMCID: PMC11241675. Go to original source... Go to PubMed...
  21. Klener P, Scott Alexander M, Cullen JJ, et al. The benefits of ascorbate to protect healthy cells in the prevention and treatment of oncological diseases. J Appl Biomed. 2020 Mar;18(1):1-7. doi: 10.32725/jab.2020.003. Epub 2020 Feb 19. PMID: 34907706. Go to original source... Go to PubMed...
  22. Pereira M, Cardeiro M, Frankel L, et al. Increased Vitamin C Intake Is Associated With Decreased Pancreatic Cancer Risk. World J Oncol. 2024 Aug;15(4):543-549. doi: 10.14740/wjon1854. Epub 2024 Jul 5. PMID: 38993260; PMCID: PMC11236377. Go to original source... Go to PubMed...
  23. Conte E, Rizzolo E, Flower G, et al. Intravenous Vitamin C in Cancer Care: Evidence Review and Practical Guidance for Integrative Oncology Practitioners. CAND Journal. 2024; 31(1):Article 1. https://doi.org/10.54434/candj.149. Go to original source...
  24. 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. 1974 Oct;9(4):285-315. doi: 10.1016/0009-2797(74)90019-2. PMID: 4430016. Go to original source... Go to PubMed...
  25. 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. 1985 Jan 17;312(3):137-41. doi: 10.1056/NEJM198501173120301. PMID: 3880867. Go to original source... Go to PubMed...
  26. Stephenson CM, Levin RD, Spector T, et al. Phase I clinical trial to evaluate the safety, tolerability, and pharmacokinetics of high­‑dose intravenous ascorbic acid in patients with advanced cancer. Cancer Chemother Pharmacol. 2013 Jul;72(1):139-46. doi: 10.1007/s00280-013-2179-9. Epub 2013 May 14. PMID: 23670640; PMCID: PMC3691494. Go to original source... Go to PubMed...
  27. Chen Q, Espey MG, Sun AY, et al. Pharmacologic doses of ascorbate act as a prooxidant and decrease growth of aggressive tumor xenografts in mice. Proc Natl Acad Sci U S A. 2008 Aug 12;105(32):11105-9. doi: 10.1073/pnas.0804226105. Epub 2008 Aug 4. PMID: 18678913; PMCID: PMC2516281. Go to original source... Go to PubMed...
  28. Polireddy K, Dong R, Reed G, et al. High Dose Parenteral Ascorbate Inhibited Pancreatic Cancer Growth and Metastasis: Mechanisms and a Phase I/IIa study. Sci Rep. 2017 Dec 7;7(1):17188. doi: 10.1038/s41598-017-17568-8. PMID: 29215048; PMCID: PMC5719364. Go to original source... Go to PubMed...
  29. Schoenfeld JD, Sibenaller ZA, Mapuskar KA, et al. O2- and H2O2-Mediated Disruption of Fe Metabolism Causes the Differential Susceptibility of NSCLC and GBM Cancer Cells to Pharmacological Ascorbate. Cancer Cell. 2017 Apr 10;31(4):487-500.e8. doi: 10.1016/j.ccell.2017. 02. 018. Epub 2017 Mar 30. Erratum in: Cancer Cell. 2017 Aug 14;32(2):268. doi: 10.1016/j.ccell.2017. 07. 008. PMID: 28366679; PMCID: PMC5497844. Go to original source...
  30. Takahashi H, Mizuno H, Yanagisawa A. High­‑dose intravenous vitamin C improves quality of life in cancer patients. Personalized Medicine Universe. 2012;1:49-53. https://doi.org/10.1016/j.pmu.2012. 05. 008. Go to original source...
  31. 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. 2011 Nov­‑Dec;25(6):983-90. PMID: 22021693.
  32. 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. 2007 Feb;22(1):7-11. doi: 10.3346/jkms.2007. 22. 1. 7. PMID: 17297243; PMCID: PMC2693571. Go to original source...
  33. Riordan HD, Casciari JJ, González MJ, et al. A pilot clinical study of continuous intravenous ascorbate in terminal cancer patients. P R Health Sci J. 2005 Dec;24(4):269-76. PMID: 16570523.
  34. Nielsen TK, Højgaard M, Andersen JT, et al. Weekly ascorbic acid infusion in castration­‑resistant prostate cancer patients: a single­‑arm phase II trial. Transl Androl Urol. 2017 Jun;6(3):517-528. doi: 10.21037/tau.2017. 04. 42. PMID: 28725594; PMCID: PMC5503969. Go to original source...
  35. Hoffer LJ, Levine M, Assouline S, et al. Phase I clinical trial of i.v. ascorbic acid in advanced malignancy. Ann Oncol. 2008 Nov;19(11):1969-74. doi: 10.1093/annonc/mdn377. Epub 2008 Jun 9. Erratum in: Ann Oncol. 2008 Dec;19(12):2095. PMID: 18544557. Go to original source... Go to PubMed...
  36. Ferraro PM, Curhan GC, Gambaro G, et al. Total, Dietary, and Supplemental Vitamin C Intake and Risk of Incident Kidney Stones. Am J Kidney, DiS. 2016 Mar;67(3):400-7. doi: 10.1053/j.ajkd.2015. 09. 005. Epub 2015 Oct 14. PMID: 26463139; PMCID: PMC4769668. Go to original source...
  37. Thomas LD, Elinder CG, Tiselius HG, et al. Ascorbic acid supplements and kidney stone incidence among men: a prospective study. JAMA Intern Med. 2013 Mar 11;173(5):386-8. doi: 10.1001/jamainternmed.2013.2296. PMID: 23381591. Go to original source... Go to PubMed...
  38. Drisko JA, Chapman J, Hunter VJ. The use of antioxidants with first­‑line chemotherapy in two cases of ovarian cancer. J Am Coll Nutr. 2003 Apr;22(2):118-23. doi: 10.1080/07315724.2003.10719284. PMID: 12672707. Go to original source... Go to PubMed...
  39. González J, Berdiel MJ, Miranda­‑Massari MR, et al. High dose intravenous vitamin C and metastatic pancreatic cancer: Two cases. Integrative Cancer Science and Therapeutics. 2016;3(6). https://doi.org/10.15761/ICST.1000219. Go to original source...
  40. Padayatty SJ, Riordan HD, Hewitt SM, et al. Intravenously administered vitamin C as cancer therapy: three cases. CMAJ. 2006 Mar 28;174(7):937-42. doi: 10.1503/cmaj.050346. PMID: 16567755; PMCID: PMC1405876. Go to original source... Go to PubMed...
  41. Riordan HD, Riordan NH, Jackson JA, et al. Intravenous vitamin C as a chemotherapy agent: a report on clinical cases. P R Health Sci J. 2004 Jun;23(2):115-8. PMID: 15377059.
  42. Seo MS, Kim JK, Shim JY. High­‑Dose Vitamin C Promotes Regression of Multiple Pulmonary Metastases Originating from Hepatocellular Carcinoma. Yonsei Med J. 2015 Sep;56(5):1449-52. doi: 10.3349/ymj.2015. 56. 5.1449. PMID: 26256994; PMCID: PMC4541681. Go to original source...
  43. Carr AC, McCall C. The role of vitamin C in the treatment of pain: new insights. J Transl Med. 2017 Apr 14;15(1):77. doi: 10.1186/s12967-017-1179-7. PMID: 28410599; PMCID: PMC5391567. Go to original source... Go to PubMed...
  44. Günes­‑Bayir A, Kiziltan HS. Palliative Vitamin C Application in Patients with Radiotherapy­‑Resistant Bone Metastases: A Retrospective Study. Nutr Cancer. 2015;67(6):921-5. doi: 10.1080/01635581.2015.1055366. Epub 2015 Jul 13. PMID: 26168394. Go to original source... Go to PubMed...
  45. Hoffer LJ, Robitaille L, Zakarian R, et al. High­‑dose intravenous vitamin C combined with cytotoxic chemotherapy in patients with advanced cancer: a phase I­‑II clinical trial. PLoS One. 2015 Apr 7;10(4):e0120228. doi: 10.1371/journal.pone.0120228. PMID: 25848948; PMCID: PMC4388666. Go to original source... Go to PubMed...
  46. Klimant E, Wright H, Rubin D, et al. Intravenous vitamin C in the supportive care of cancer patients: a review and rational approach. Curr Oncol. 2018 Apr;25(2):139-148. doi: 10.3747/co.25.3790. Epub 2018 Apr 30. PMID: 29719430; PMCID: PMC5927785. Go to original source... Go to PubMed...
  47. Mansoor F, Kumar S, Rai P, et al. Impact of Intravenous Vitamin C Administration in Reducing Severity of Symptoms in Breast Cancer Patients During Treatment. Cureus. 2021 May 6;13(5):e14867. doi: 10.7759/cureus.14867. PMID: 34113504; PMCID: PMC8177022. Go to original source... Go to PubMed...
  48. ClinicalTrials.gov, NCT04516681. (n.d.). Retrieved 18 July 2024, from https://clinicaltrials.gov/study/NCT04516681?term=NCT04516681 & rank=1.
  49. Bruckner H, Hirschfeld A, Gurell D, et al. Broad safety impact of high­‑dose ascorbic acid and induction chemotherapy for high­‑risk pancreatic cancer. Journal of Clinical Oncology. 2017;35:e15711-e15711. https://doi.org/10.1200/JCO.2017. 35. 15_suppl.e15711. Go to original source...
  50. Allen BG, Bodeker KL, Smith MC, et al. First­‑in­‑Human Phase I Clinical Trial of Pharmacologic Ascorbate Combined with Radiation and Temozolomide for Newly Diagnosed Glioblastoma. Clin Cancer Res. 2019 Nov 15;25(22):6590-6597. doi: 10.1158/1078-0432.CCR-19-0594. Epub 2019 Aug 19. PMID: 31427282; PMCID: PMC6858950. Go to original source... Go to PubMed...
  51. Alexander MS, Wilkes JG, Schroeder SR, et al. Pharmacologic Ascorbate Reduces Radiation­‑Induced Normal Tissue Toxicity and Enhances Tumor Radiosensitization in Pancreatic Cancer. Cancer Res. 2018 Dec 15;78(24):6838-6851. doi: 10.1158/0008-5472.CAN-18-1680. Epub 2018 Sep 25. PMID: 30254147; PMCID: PMC6295907. Go to original source... Go to PubMed...
  52. Kawada H, Sawanobori M, Tsuma­‑Kaneko M, et al. Phase I Clinical Trial of Intravenous L­‑ascorbic Acid Following Salvage Chemotherapy for Relapsed B­‑cell non­‑Hodgkin's Lymphoma. Tokai J Exp Clin Med. 2014 Sep 20;39(3):111-5. PMID: 25248425.
  53. Wang F, He MM, Wang ZX, et al. Phase I study of high­‑dose ascorbic acid with mFOLFOX6 or FOLFIRI in patients with metastatic colorectal cancer or gastric cancer. BMC Cancer. 2019 May 16;19(1):460. doi: 10.1186/s12885-019-5696-z. PMID: 31096937; PMCID: PMC6524297. Go to original source... Go to PubMed...
  54. ClinicalTrials.gov, NCT00441207. (n.d.). ClinTrials.Gov. Retrieved 18 July 2024, from https://clinicaltrials.gov/study/NCT00441207.
  55. Dachs GU, Gandhi J, Wohlrab C, et al. Vitamin C Administration by Intravenous Infusion Increases Tumor Ascorbate Content in Patients With Colon Cancer: A Clinical Intervention Study. Front Oncol. 2021 Jan 11;10:600715. doi: 10.3389/fonc.2020.600715. PMID: 33505915; PMCID: PMC7830882. Go to original source... Go to PubMed...
  56. Drisko JA, Serrano OK, Spruce LR, Chen Q, Levine M. Treatment of pancreatic cancer with intravenous vitamin C: a case report. Anticancer Drugs. 2018 Apr;29(4):373-379. doi: 10.1097/CAD.0000000000000603. PMID: 29438178; PMCID: PMC5882293. Go to original source... Go to PubMed...
  57. Furqan M, Abu­‑Hejleh T, Stephens LM, et al. Pharmacological ascorbate improves the response to platinum­‑based chemotherapy in advanced stage non­‑small cell lung cancer. Redox Biol. 2022 Jul;53:102318. doi: 10.1016/j.redox.2022.102318. Epub 2022 Apr 20. PMID: 35525024; PMCID: PMC9079696. Go to original source... Go to PubMed...
  58. Mikirova N, Riordan N, Casciari J. Modulation of Cytokines in Cancer Patients by Intravenous Ascorbate Therapy. Med Sci Monit. 2016 Jan 3;22:14-25. doi: 10.12659/msm.895368. PMID: 26724916; PMCID: PMC4756791. Go to original source... Go to PubMed...
  59. Nielsen TK, Højgaard M, Andersen JT, et al. Elimination of ascorbic acid after high­‑dose infusion in prostate cancer patients: a pharmacokinetic evaluation. Basic Clin Pharmacol Toxicol. 2015 Apr;116(4):343-8. doi: 10.1111/bcpt.12323. Epub 2014 Oct 7. PMID: 25220574. Go to original source... Go to PubMed...
  60. Wang F, He MM, Xiao J, et al. A Randomized, Open­‑Label, Multicenter, Phase 3 Study of High­‑Dose Vitamin C Plus FOLFOX ± Bevacizumab versus FOLFOX ± Bevacizumab in Unresectable Untreated Metastatic Colorectal Cancer (VITALITY Study). Clin Cancer Res. 2022 Oct 3;28(19):4232-4239. doi: 10.1158/1078-0432.CCR-22-0655. PMID: 35929990; PMCID: PMC9527503. Go to original source... Go to PubMed...




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