Written by Luc Geeraert and the CAM-Cancer Consortium.
Updated September 30, 2015

Vitamin E during cancer treatment

Is it safe?

Adverse events

Vitamin E is considered to have a very low toxicity, and is generally well-tolerated 5. The vitamin is not mutagenic, teratogenic nor carcinogenic 48. Humans show few side effects following supplemental doses below 2,100 mg of alpha-tocopherol per day for a few weeks to a few months. The effects of life-long exposure to high doses of alpha-tocopherol supplements are unknown 5.

In vitro, alpha-tocopherol was found to inhibit platelet aggregation 49. In the ATBC cancer prevention study, a higher mortality due to haemorrhagic stroke was found in the all-rac-alpha-tocopherol treatment group 50. In adults, high-dose alpha-tocopherol supplementation (1,000 IU per day) antagonized vitamin K, which is a crucial vitamin in clotting 51. A population study showed that vitamin E supplementation (of 400 IU per day or more) was associated with a significantly increased risk of mortality in people with a history of severe cardiovascular disease 52. In conclusion, vitamin E can affect bleeding and carries the risk of haemorrhagic stroke, and special consideration should therefore be given to cardiovascular disease patients or individuals taking nitrates or the anticoagulant warfarin, and to those with vitamin-K-related clotting disorders 5.

In a meta-analysis of 19 clinical trials (9 tested vitamin E alone) with a total of 135,967 participants, it was found that daily supplementation of more than 400 IU may increase all-cause mortality, an effect which was dose-dependent 53. Hence, non-healthy patients should not take daily doses of 400 IU or higher.

Vitamin E might have the potential to increase the risk of second primary cancers, and to increase the all-cause mortality in patients with head and neck cancer 18-20.

Little information is available on the adverse events of other forms of vitamin E 5.

Contraindications

Special consideration should be given when high doses of vitamin E are administered to individuals with cardiovascular disease, taking anticoagulant therapy (e.g., warfarin) or vitamin-K-related clotting disorders, as high doses of alpha-tocopherol may increase the bleeding tendency 5.

Non-healthy individuals should not take daily doses of 400IU or higher 53.

Interactions

As vitamin E has antioxidant properties, a negative effect on the anticancer activity of therapies generating increased reactive oxygen species, e.g. radiation and some chemotherapeutics, is conceivable 54.

Little research has investigated the influence of vitamin E on the activity of chemotherapeutic drugs or radiation. In most of the few studies performed in vitro and in tumor-bearing mice, no negative effect and even an enhancement of the anticancer effect of chemotherapeutic drugs or radiation was observed 9 55-57. However, one in vitro study showed that alpha-tocopherol inhibited the antiproliferative and proapoptotic effects of different chemotherapeutic agents belonging to the class of protein kinase inhibitors 58. In cancer patients, no evidence was found for a negative effect of vitamin E on chemotherapeutic treatment outcome 59 60

Citation Luc Geeraert, CAM-Cancer Consortium. Vitamin E during cancer treatment [online document]. http://ws.cam-cancer.org/The-Summaries/Dietary-approaches/Vitamin-E-during-cancer-treatment. September 30, 2015.

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