The use of coenzyme Q₁₀ as a treatment for cancer in humans has been investigated in only a limited manner. With the exception of a single randomized trial,[1] which involved 20 patients and tested the ability of coenzyme Q₁₀ to reduce the cardiotoxicity caused by anthracycline drugs, the studies that have been published consist of anecdotal reports, case reports, case series, and uncontrolled clinical studies.[2-7] Reviewed in [8-11]

In view of the promising results from animal studies, coenzyme Q₁₀ was tested as a protective agent against the cardiac toxicity observed in cancer patients treated with the anthracycline drug doxorubicin. It has been postulated that doxorubicin interferes with energy-generating biochemical reactions that involve coenzyme Q₁₀ in heart muscle mitochondria and that this interference can be overcome by coenzyme Q₁₀ supplementation.[3,12,13] Studies with adults and children, including the aforementioned randomized trial, have confirmed the decrease in cardiac toxicity observed in animal studies.[1-4]

The potential of coenzyme Q₁₀ as an adjuvant therapy for cancer has also been explored. In view of observations that blood levels of coenzyme Q₁₀ are frequently reduced in cancer patients,[14,15] Reviewed in [7,9,10] supplementation with this compound has been tested in patients undergoing conventional treatment. An open-label (nonblinded), uncontrolled clinical study in Denmark followed 32 breast cancer patients for 18 months.[5] The disease in these patients had spread to the axillary lymph nodes, and an unreported number had distant metastases. The patients received antioxidant supplementation (vitamin C, vitamin E, and beta carotene), other vitamins and trace minerals, essential fatty acids, and coenzyme Q₁₀ (at a dose of 90 mg /day), in addition to standard therapy (surgery, radiation therapy, and chemotherapy, with or without tamoxifen). The patients were seen every 3 months to monitor disease status (progressive disease or recurrence), and, if there was a suspicion of recurrence, mammography, bone scan, x-ray, or biopsy was performed. The survival rate for the study period was 100% (4 deaths were expected). Six patients were reported to show some evidence of remission; however, incomplete clinical data were provided, and information suggestive of remission was presented for only 3 of the 6 patients. None of the 6 patients had evidence of further metastases. For all 32 patients, decreased use of painkillers, improved quality of life, and an absence of weight loss were reported. Whether painkiller use and quality of life were measured objectively (e.g., from pharmacy records and validated questionnaires, respectively) or subjectively (from patient self-reports) was not specified.

In a follow-up study, 1 of the 6 patients with a reported remission and a new patient were treated for several months with higher doses of coenzyme Q₁₀ (390 and 300 mg/day, respectively).[6] Surgical removal of the primary breast tumor in both patients had been incomplete. After 3 to 4 months of high-level coenzyme Q₁₀ supplementation, both patients appeared to experience complete regression of their residual breast tumors (assessed by clinical examination and mammography). It should be noted that a different patient identifier was used in the follow-up study for the patient who had participated in the original study. Therefore, it is impossible to determine which of the 6 patients with a reported remission took part in the follow-up study. In the follow-up study report, the researchers noted that all 32 patients from the original study remained alive at 24 months of observation, whereas 6 deaths had been expected.[6]

In another report by the same investigators, 3 breast cancer patients were followed for a total of 3 to 5 years on high-dose coenzyme Q₁₀ (390 mg/day).[7] One patient had complete remission of liver metastases (determined by clinical examination and ultrasonography), another had remission of a tumor that had spread to the chest wall (determined by clinical examination and chest x-ray), and the third patient had no microscopic evidence of remaining tumor after a mastectomy (determined by biopsy of the tumor bed).

All 3 of the above-mentioned human studies [5-7] had important design flaws that could have influenced their outcome. Study weaknesses include the absence of a control group (i.e., all patients received coenzyme Q₁₀), possible selection bias in the follow-up investigations, and multiple confounding variables (i.e., the patients received a variety of supplements in addition to coenzyme Q₁₀, and they received standard therapy either during or immediately before supplementation with coenzyme Q₁₀). Thus, it is impossible to determine whether any of the beneficial results was directly related to coenzyme Q₁₀ therapy.

Anecdotal reports of coenzyme Q₁₀ lengthening the survival of patients with pancreatic, lung, rectal, laryngeal, colon, and prostate cancers also exist in the peer-reviewed, scientific literature.[4] The patients described in these reports also received therapies other than coenzyme Q₁₀, including chemotherapy, radiation therapy, and surgery.

Refer to the NCI Web site for a list of active clinical trials evaluating the use of coenzyme Q₁₀ in cancer patients.

References

1. Iarussi D, Auricchio U, Agretto A, et al.: Protective effect of coenzyme Q10 on anthracyclines cardiotoxicity: control study in children with acute lymphoblastic leukemia and non-Hodgkin lymphoma. Mol Aspects Med 15 (Suppl): s207-12, 1994.  [PUBMED Abstract]
   
   
2. Folkers K, Wolaniuk A: Research on coenzyme Q10 in clinical medicine and in immunomodulation. Drugs Exp Clin Res 11 (8): 539-45, 1985.  [PUBMED Abstract]
   
   
3. Cortes EP, Gupta M, Chou C, et al.: Adriamycin cardiotoxicity: early detection by systolic time interval and possible prevention by coenzyme Q10. Cancer Treat Rep 62 (6): 887-91, 1978.  [PUBMED Abstract]
   
   
4. Folkers K, Brown R, Judy WV, et al.: Survival of cancer patients on therapy with coenzyme Q10. Biochem Biophys Res Commun 192 (1): 241-5, 1993.  [PUBMED Abstract]
   
   
5. Lockwood K, Moesgaard S, Hanioka T, et al.: Apparent partial remission of breast cancer in 'high risk' patients supplemented with nutritional antioxidants, essential fatty acids and coenzyme Q10. Mol Aspects Med 15 (Suppl): s231-40, 1994.  [PUBMED Abstract]
   
   
6. Lockwood K, Moesgaard S, Folkers K: Partial and complete regression of breast cancer in patients in relation to dosage of coenzyme Q10. Biochem Biophys Res Commun 199 (3): 1504-8, 1994.  [PUBMED Abstract]
   
   
7. Lockwood K, Moesgaard S, Yamamoto T, et al.: Progress on therapy of breast cancer with vitamin Q10 and the regression of metastases. Biochem Biophys Res Commun 212 (1): 172-7, 1995.  [PUBMED Abstract]
   
   
8. Complementary treatments highlighted at recent meeting. Oncology (Huntingt) 13 (2): 166, 1999.  [PUBMED Abstract]
   
   
9. Folkers K: Relevance of the biosynthesis of coenzyme Q10 and of the four bases of DNA as a rationale for the molecular causes of cancer and a therapy. Biochem Biophys Res Commun 224 (2): 358-61, 1996.  [PUBMED Abstract]
   
   
10. Ren S, Lien EJ: Natural products and their derivatives as cancer chemopreventive agents. Prog Drug Res 48: 147-71, 1997.  [PUBMED Abstract]
    
    
11. Hodges S, Hertz N, Lockwood K, et al.: CoQ10: could it have a role in cancer management? Biofactors 9 (2-4): 365-70, 1999.  [PUBMED Abstract]
    
    
12. Usui T, Ishikura H, Izumi Y, et al.: Possible prevention from the progression of cardiotoxicity in adriamycin-treated rabbits by coenzyme Q10. Toxicol Lett 12 (1): 75-82, 1982.  [PUBMED Abstract]
    
    
13. Iwamoto Y, Hansen IL, Porter TH, et al.: Inhibition of coenzyme Q10-enzymes, succinoxidase and NADH-oxidase, by adriamycin and other quinones having antitumor activity. Biochem Biophys Res Commun 58 (3): 633-8, 1974.  [PUBMED Abstract]
    
    
14. Folkers K: The potential of coenzyme Q 10 (NSC-140865) in cancer treatment. Cancer Chemother Rep 2 4 (4): 19-22, 1974.  [PUBMED Abstract]
    
    
15. Folkers K, Osterborg A, Nylander M, et al.: Activities of vitamin Q10 in animal models and a serious deficiency in patients with cancer. Biochem Biophys Res Commun 234 (2): 296-9, 1997.  [PUBMED Abstract]
    
    

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