高劑量維他命C


高劑量維他命C


台中醫院廖志穎醫師





快速了解:

。目前無足夠強證據證明高劑量C可以治療癌症

。高劑量C提供抗氧化、機轉:主要在細胞內產生高量的H2O2(過氧化氫),正常細胞可排出,癌細胞無法排出,導致癌細胞凋亡。

。初步人體試驗明顯改善化放療副作用(疲憊/噁心/生活品質)

。高劑量C必須採靜脈注射,方達到有效濃度 20mM

。實驗室發現C有抗氧化作用與減少攝護腺、胰臟、肝、大腸、間皮、神經母細胞瘤癌在培養皿細胞株的分裂,但有些結果卻讓腫瘤惡化更快。

。動物實驗有減緩腫瘤生長的現象。

。兩篇人體研究發現C有改善末期癌症病人生活品質與減少癌症治療相關副作用(噁心、嘔吐等)。

。2017 phase II 臨床試驗,高劑量C在腦癌與肺癌,合併化放療使用,
無明顯副作用,且存活延長將近半年。

概論

高劑量維他命C(學名 ascorbate or L-ascorbic acid,很多癌友應該不陌生,我們採用美國國家整合健康機構(NCCIH)的專家分析,在細胞、動物、人體試驗的結果給大家參考!

高劑量維他命C的研究從1970年開始:

一般資訊


維他命C是氧化還原的基礎營養素,是多種酵素的輔助因子 、幫助合成膠原蛋白,20世紀中期,有研究假定維他命C缺乏造成的結締組織問題會造成癌症,間接認為C有治療癌症的潛力,人體缺乏轉化維他命C的酵素,所以比需從食物或補充品補充!


歷史


最早使用高劑量維他命C(注射型)作為癌症治療的是1970年代蘇格蘭外科醫師 Ewan Cameron 和他同事 Allan Campbell,並和諾貝爾化學獎得主Linus Pauling合作,兩個臨床試驗在1970晚期到1980早期分別發表。

藥理學實驗,口服C只能達到少於 300 µM的血漿濃度.若注射型可達 20 mM,此高濃度在細胞培養皿中,可能可以殺死癌細胞。2006-2008年間,C很常用於感染、癌症、疲憊。

培養皿細胞/動物/臨床前期實驗

細胞培養皿實驗 

多篇實驗室研究高濃度C (0.1–100 mM)減少攝護腺、胰臟、肝、大腸、間皮、神經母細胞瘤癌細胞株的分裂。

機轉可能與直接的產生過氧化物的細胞毒殺作用有關,或與調控癌細胞生長的蛋白質有關,或是啟動免疫自我吞噬機轉。

有些研究發現C可以增強化療藥在癌細胞株的療效如:卵巢、胰臟、間皮細胞瘤,或加強惡性星狀細胞瘤(腦瘤)的放射線敏感度。

但也有些癌細胞株卻沒有得到更好效果(血癌、多發性骨髓瘤),甚至惡化。

動物實驗

部分動物實驗中,可看到高劑量C可抑制胰臟、肝、攝護腺、肌肉瘤、卵巢癌的生長。

在與胰臟癌化療藥健則(Gemzar)合並使用中,在一個乳癌動物光動力療法中,在一個動物卵巢癌合併第一線化療藥中,合併高劑量C有增強細胞毒殺效果。

人體臨床試驗 



早期單用高劑量C試驗

1970年代,數篇案例報告,50位晚期癌症病人,在結束傳統癌症治療後,接受注射或口服高劑量維生素C (10 g/day)。有的沒有效果、有的一點效果,有的縮小或有的出血。1975年一個 reticulum cell sarcoma的病人,肺部轉移腫瘤在使用C後有縮小,但一沒使用C腫瘤與症狀又開始恢復。

1976一個大型 100位癌症末期的病人個案報告,使用高劑量C,和同時期醫院裡沒使用人,平均存活比沒使用的人多三百天(此非隨機臨床試驗,有失比較客觀性)。

兩個嚴謹的臨床試驗,試著採用上面的模式,給予比較高劑量C的結果,發現在疾病症狀、生活體能、存活率沒有顯著差異[5,6]

近期臨床試驗

一份案例報告說明三個個案,病理化驗腫瘤惡性度高,接受靜脈維他命C後存活有比過往歷史資料長(非嚴謹試驗)
。 
兩份報告指出C改善病人生活品質與減少副作用。

C合併其他治療臨床試驗

2012年一個第一期胰臟癌臨床試驗測試維他命C與化療 gemcitabine 與標靶藥-得舒緩的安全性,合併使用並沒有明顯不良反應,17位病人中有九位疾病為穩定狀態!

2013年另一個第一期末期胰臟癌臨床試驗中,九位病人無疾病惡化存活率為26週,平均存活12個月。

2014年一個第一/二期卵巢癌臨床試驗,Vit C合併化療卡鉑、太平洋紫杉醇使,27位隨機分派化療或是化療加C組別,發現加C的組別有較少的化療毒性與副作用(p<0.05),有延遲腫瘤惡化的效果(25.5 vs 16.75 月) (但未達統計意義,可能與人數過少有關)。 


2017年愛荷華大學的臨床研究:給予第四期肺癌或惡性腦瘤(GBM)患者高劑量維他命C血中濃度達20000 μM (一般人僅70μM),無明顯副作用,且存活延長將近半年。登上Cancer Cell今年四月期刊 (資料)。

但類似的組合卻在急性骨髓白血病、復發轉移大腸癌、轉移黑色素瘤看到更多副作用、與疾病惡化更快的問題。

目前正在進型的臨床試驗
查詢 NCI website.網站

不良反應
一般注射的維他命C耐受度良好,腎功能不全、G6PD會造成溶血,和提高血液凝滯,這些人要特別注意。

少數人因濃度問題輸注過程中會頭痛、胃痙攣、頭暈、噁心感、口渴的感覺。
總結:
高劑量維他命C雖然沒有顯著毒性,但G6PD患者、腎功能、結石患者要注意使用。
臨床上僅有比較明確改善治療副作用(治療引起疲憊/噁心嘔吐感/生活品質)的證據或用在支持療法時,改善生活品質,若用高劑量C來毒殺癌細胞、治療腫瘤還沒足夠充分證據的,臨床人體第一二期顯示合併傳統化放療式安全的,少數癌別有穩定病情的情況,需進行更多人體試驗才能確定它的功能和角色!

歡迎到台中醫院廖志穎醫師門診諮詢~!
線上討論諮詢
參考文獻
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