Table 2.
Summary of the evidence (described in Section 5) on nutritional interventions to enhance BC treatment.
| Study | Intervention | Results | Reference | |
|---|---|---|---|---|
| ω-3 PUFAs | Phase II clinical trial (n = 25 breast cancer patients, 31 months follow-up) | 1.8 g DHA/day anthracycline | Improvement of chemo-therapy outcome: median TTP = 6 months (95% CI, 2.8–8.7 months); median OS = 22 months (95% CI, 17–33 months) No severe adverse side effects (grade 3 or 4 toxicity only for neutropenia and alopecia, 80%) |
[99] |
| Pilot study (n = 38 postmenopausal breast cancer patients) | 4 g/day EPA + DHA for 3 months AI therapy | Inhibition of bone resorption in the fish oil responders vs. placebo (p < 0.05) | [100] | |
| Controlled clinical trial (n = 249 postmenopausal breast cancer patients) | 3.3 g/day ω3 PUFA (560 mg EPA + DHA, 40:20 ratio) 24 weeks AI therapy | Reduction of arthralgia (4.36 vs. 5.70, p = 0.02) obese BC patients vs. placebo | [101] | |
| Controlled clinical trial (n = 20 breast cancer patients) | EPA (0.19 g/day) + DHA (1.04 g/day) paclitaxel | Reduction of paclitaxel-induced peripheral neuropathy incidence (OR = 0.3; 95% CI, 0.10–0.88, p = 0.029), but not severity (0.95% CI = (−2.06–0.02), p = 0.054) EPA + DHA vs. placebo | [102] | |
| Green tea | Prospective cohort study (n = 1160 breast cancer patients, 8 years follow-up) | Regular consumption of green tea | Inverse association between regular green tea consumption (≥3 cups/day) and BC recurrence for stage I/II patients (HR = 0.69; 95% CI, 0.47–1.00, p < 0.05) | [103] |
| Prospective cohort study (n = 472 breast cancer patients, 7 years follow-up) | Regular consumption of green tea | Inverse association between regular green tea consumption (≥5 cups/day) and BC recurrence for stage I/II patients (RR = 0.564; 95% CI, 0.350–0.911, p < 0.05) | [104] | |
| Prospective cohort study (n = 5042, 9.1 years follow-up) | Regular consumption of green tea | Reduced risk of total mortality (HR = 0.57; 95% CI: 0.34–0.93) and recurrence (HR = 0.54; 95% CI: 0.31–0.96) for the first 60-month post-diagnosis period | [105] | |
| Vitamin C | Controlled clinical trial (n = 54 post-menopausal breast cancer patients) | Vitamin C (500 mg) and E (400 mg) +tamoxifen (10 mg twice a day) for 90 days | Decrease of total cholesterol, TG, VLDL (p < 0.001) and LDL (p < 0.01) vs. tamoxifen alone Increase of HDL (p < 0.01) vs. tamoxifen alone |
[106] |
| Controlled clinical trial (n = 40 breast cancer patients) | Vitamin C (500 mg) and E (400 mg) + 5-fluorouracil (500 mg/m2) + doxorubicin (50 mg/m2) + cyclophosphamide (500 mg/m2) (every 3 weeks for six cycles) | Increase of SOD, CAT, GST, GPx, GSH (p < 0.01) vs. chemotherapy alone Decrease of MDA, DNA damage (p < 0.01) vs. chemotherapy alone |
[107] | |
| Vitamin E | Prospective cohort study (n = 7 breast cancer patients, 30 days follow-up) | Vitamin E (400 mg) + tamoxifen (20 mg daily) for 30 days | Vitamin E supplement interferes with the therapeutic effects of tamoxifen (increase expression of biomarkers of estrogen-stimulation (ER, PR, p-ERK in breast biopsies) | [108] |
| Vitamin D | Prospective cohort study (n = 232 post-menopausal breast cancer patients, 1-year follow-up) | Calcium (1 g) + vitamin D3 (800 IU/d and additional 16,000 IU, every 2 weeks) + AI therapy for 1 year | Reduction of AI-associated lumbar spine bone loss: 1.70% (95% CI, 0.4–3.0%; p = 0.005) (women with 25(OH)D serum levels ≥40 ng/ml vs. women with serum levels <30 ng/ml) | [109] |
| Prospective cohort study (n = 60 post-menopausal breast cancer patients, 16 weeks follow-up) | 50,000 IU/week + AI therapy for 12 weeks | Decrease of disability from joint pain (52 vs. 19%; p = 0.026); reduction of fatigue (BFI scores 1.4 vs. 2.9; NS); reduction of menopausal symptoms (MENQOL scores 2.2 vs. 3.2, p = 0.035) (women with 25OHD levels > 66 ng/ml vs. women with levels < 66 ng/ml) | [110] |
AI: aromatase inhibitor; BC: breast cancer; BFI: big five inventory; CAT: catalase; DHA: docosahexaenoic acid; EPA: eicosapentaenoic acid; ER: estrogen receptor; GPx: glutathione peroxidase; GSH: reduced glutathione; GST: glutathione transferase; HDL: high density lipoprotein; HR: hazard ratio; LDL: low density lipoprotein; MDA: malondialdehyde; MENQOL: menopause-specific quality of life; NS: not significant; OS: overall survival; p-ERK: phosphorylated extracellular signal–regulated kinase; PR: progesterone receptor; PUFA: poly unsaturated fatty acids; RR: relative risk; SOD: superoxide dismutase; TG: triglycerides; TTP: time to progression; VLDL: very low density lipoprotein; 25OHD: 25-hydroxycholecalciferol.