Vitamin D prevents breast cancer, reduces BC mortality, and reduces BC chemotherapy problems – Sept 2018

Vitamin D - Relevance for Incidence, Prognosis and Side Effects of Conventional Therapy in Breast Cancer

Integrative Medicine Meeting: Abstract Presentation September 18, 2018 | 3:00 - 3:20
Dr. Stephan Wey, MD
Group Practice of Dr Stephan Wey and Maria Sokoiowski, Lauf, Germany

The publication data on vitamin D3 in nearly all acute and chronic inflammatory diseases, metabolic syndrome and cancer [1,2] must lead to a consistent, year-round increase in the vitamin D levels to > 75 nmol/l (preventive) to 100-200 nmol/l (adjuvant-palliative). The vitamin D levels (25-OH) in the serum of the elderly and cancer patients often are dramatically low [3].

In primary and secondary prevention, there is a clear risk reduction with a lower incidence of breast cancer of 50-69% [4, 5, 6] or relapses with a reduction in mortality of up to 60% in a recent meta-analysis [7] in comparison of low to high Vit. D levels.

In addition, it obviously also has supportive significance: vitamin D3 levels can be reduced under chemotherapy, e.g. fall with anthracyclines, cyclophosphamide and taxanes, as these are pregnane X receptor ligands and so trigger an enzyme induction of 24-hydroxylase the increased degradation of 25 (OH) D and 1,25 (OH) D! Other substances used in oncology, such as dexamethasone, tamoxifen and aromatase inhibitors have the same negative effect for vitamin D levels [8].

According to small-scale studies, the active administration of vitamin D has a lowering effect on side effects such as stomatitis and taste disorders related to chemotherapy [9] or fatigue and arthralgia on aromatase inhibitors [10, 11] or jaw necrosis related to bisphosphonates [12].

In palliative pain therapy, an existing vitamin D deficiency leads to higher opioid dosages for pain control [13].

In practical consequence, every (breast) cancer patient should, depending on season, body weight u. a. factors, receive vitamin D3 between 1000 and 5000 IU daily to reach the target levels of 100-200 nmol/l.

Literature:

1. Lappe JM, Travers-Gustafson D, Davies KM, Recker RR, Heaney RP. Vitamin D and calcium supplementation reduces cancer risk: results of a randomized trial. Am J Clin Nutr 2007; 85: 1586-1591
2. Churilla TM, Brereton HD, Klem M. Vitamin D deficiency is widespread in cancer patients and correlates with advanced stage disease: a community oncology experience. Nutr Cancer 2012; 64: 521-525
3. Schilling S. Epidemic vitamin D deficiency among patients in an elderly care rehabilitation facility. Dtsch Arztebl Int 2012; 109: 33-38
4. Abbas, S., Linseisen, J., Slanger, T., Kropp, S., Mutschelknauss, E. J., Flesch-Janys, D., & Chang-Claude, J. (2007). Serum 25-hydroxyvitamin D and risk of post-menopausal breast cancer-results of a large case-control study. Carcinogenesis, 29(1), 93-99
5. Garland, C. F., Gorham, E. D., Mohr, S. B., Grant, W. B., Giovannucci, E. L., Lipkin, M., ... & Garland, F. C. (2007). Vitamin D and prevention of breast cancer: pooled analysis. The Journal of steroid biochemistry and molecular biology, 103(3), 708-711
6. Goodwin PJ, Ennis M, Pritchard KI. Prognostic effects of 25-hydroxyvitamin D levels in early breast cancer. J Clin Oncol 2009; 27: 3757-3763
7. Mohr SB, Gorham ED, Kim J, Hofflich H, Garland CF. Meta-analysis of vitamin D sufficiency for improving survival of patients with breast cancer. Anticancer research 2014; 34: 1163-1166
8. Santini D, Galluzzo S, Vincenzi B. Longitudinal evaluation of vitamin D plasma levels during anthracycline- and docetaxel-based adjuvant chemotherapy in early-stage breast cancer patients. Ann Oncol 2010; 21: 185-186
9. Fink M. Vitamin D deficiency is a cofactor of chemotherapy-induced mucocutaneous toxicity and dysgeusia. J Clin Oncol 2011; 29:e81-e82
10. Prieto-Alhambra D, Javaid MK, Servitja S. Vitamin D threshold to prevent aromatase inhibitor-induced arthralgia: a prospective cohort study. Breast Cancer Res Treat 2011; 125: 869-878
11. Khan QJ, Reddy PS, Kimler BF. Effect of vitamin D supplementation on serum 25- hydroxy vitamin D levels, joint pain, and fatigue in women starting adjuvant letrozole treatment for breast cancer. Breast Cancer Res Treat 2010; 119: 111-118
12. Bedogni A, Saia G, Bettini G, Tronchet A, Totola A, Bedogni G, Nocini PF.
13. Osteomalacia: the missing link in the pathogenesis of bisphosphonate-related osteonecrosis of the jaws?. The oncologist 2012; 17: 1114-1119
14. Bergman P, Sperneder S, Hoijer J, Bergqvist J, Bjorkhem-Bergman L. Low vitamin D levels are associated with higher opioid dose in palliative cancer patients-results from an observational study in Sweden. PLoS One 2015; 10: e0128223