Filling up vitamin D deficiency improves the forecast of lung cancer

reference

t. Akiba, T. Morikaawa, M. Odaka et al. Vitamin D supplementation and survival of patients with non-small cell lung cancer: a randomized, double-blind, placebo-controlled Study. (Link away). 2018; 24 (17): 4089-4097.

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Double -blind placebo -controlled study

participant

The study carried out in Tokyo, Japan, comprised 155 patients aged 20 to 75 who had undergone an operation due to non-small cell lung cancer (NSCLC). Patients who already took vitamin D were excluded.

Intervention

The patient received either 1,200 IE/day vitamin D supplement (n = 77) or placebo (n = 78) for 1 year after the operation and were followed up over a median period of 3.3 years.

results

The primary and secondary endpoints were the recurrent survival (RFS) or overall survival (OS).

important knowledge

relapses occurred at 40 (28 %) and deaths in 24 (17 %) of all patients. In the vitamin D group, neither the RFS nor in the OS found a significant difference in the entire study population compared to the placebo group. However, in the sub-group with adenocarcinoma in early stages and with low (<20 ng/ml) 25-hydroxyvitamin D [25 (oh) D] The vitamin D arm showed a significantly better 5-year-RFS (86% vs. 50%, p = 0.04) and OS (91% vs. 48%, p = 0.02) as the placebo group.

The genotypes DBP1 (RS7041) TT and CDX2 (RS11568820) AA/AG Marker were

under the investigated polymorphisms for a better forecast, also with multivariater adjustment.

clinical implications

These results do not support the generally widespread assumption that more vitamin D is better in all cancer patients and that all patients should take high doses. Instead, these results suggest that we should test vitamin D for all NSCLC patients and add those who are low, below 20 ng/ml.

The five-year survival rate of lung cancer patients is very low and is in the range of 10 % to 30 %. ^{1 Therefore, everything that could improve these gloomy numbers is examined, especially if it promises to be low in risk and inexpensive. While the new targeted medication gradually improve the survival rate, these are associated with high costs and a considerable risk. Even with Nivolumab, which was announced as a big breakthrough, 2 The 5-year survival rate is still estimated to be only 16 %. 3.4 According to a group that examined the high costs of cancer, 5 between 2000 and 2015 rose for new cancer medication from 5,000 to $ 10,000 a year at over $ 120,000 a year. 6 If vitamin D has a tiny advantage, it could improve the current treatment standard.}

In this study, vitamin D made no difference in the entire population of NSCLC patients, but it made a significant difference in patients who had low vitamin D concentrations at the beginning of the study.

vitamin D is a naturally produced hormone that is formed in the skin that was exposed to sunlight. It can also be absorbed through food or as a dietary supplement. The liver converts vitamin D into its active form 25 (OH) D. This chemical is used as a marker for the vitamin D concentration in the blood. It is mainly "activated" by the kidneys to 1.25 dihydroxyvitamin D. [1,25- (OH) 2D]. Most fabrics and most cancer types also convert 25 (OH) D into the 1.25 (OH) 2D shape. The vitamin D receptor is a nuclear receptor that regulates genes within the cell. In theory, vitamin D prevents a cancer relapse by inhibiting cell proliferation, angiogenesis and metastasis and at the same time inducing apoptosis. ⁷

Over a decade ago, Zhou et al. Patients who were operated on in summer when the vitamin D level in the body is probably higher survived longer. The authors examined the common effects of the surgical season and the intake of vitamin D preparations and found that those who were operated on in summer and had the highest vitamin D intake had a better RFS (adapted risk ratio) [HR]: 0.33; 95% confidence interval [CI]: 0.15-0.74) as patients who had winter operation with the lowest vitamin D intake; The 5-year RFS rate was 56 % (34 %-78 %) for the group with operations in summer/with high intake and 23 % (4 % to 42 %) for the group with operations in winter with low supply.

While such prospective studies report that higher 25 (OH) D levels are associated with better survival, these were all observation studies. Therefore, there was a need for a double-blind, placebo-controlled study to determine whether a 25 (OH) D-deficiency plays a causal role. This is the first interventional study that tries to clarify this question.

In this study, vitamin D made no difference in the entire population of NSCLC patients, but it made a significant difference in patients who had low vitamin D concentrations at the beginning of the study.

Based on these results, it is advisable to test the vitamin D status for all NSCLC patients and, at least in the patients whose values ​​are low, to add under 20 ng/ml. The determination of a limit of what is to be regarded as appropriate can prove to be controversial; There seems to be no risk of increasing serum concentrations higher, so that many will argue to use a higher value than 20 ng/ml to select patients at which treatment is to be started. In this study, the patients of the test group received 1,200 IE vitamin d 3 per day.