The following is a summary of “Intake and biomarkers of folate and folic acid as determinants of chemotherapy-induced toxicities in patients with colorectal cancer: a cohort study,” published in the December 2023 issue of Oncology by Kok et al.
In this investigation, the study group delved into the impacts of folate and folic acid consumption on the toxicities arising from capecitabine treatment in patients diagnosed with colorectal cancer (CRC). Capecitabine, an oral chemotherapeutic agent, hinders thymidylate synthase, an enzyme crucial in folate metabolism, to exhibit antitumor activity. The study, conducted within the COLON (Colorectal cancer: Longitudinal, Observational study on Nutritional and lifestyle factors that influence recurrence, survival and quality of life) cohort, identified 290 stage II-III CRC patients undergoing capecitabine therapy, of which dietary and supplemental intake of folate and folic acid were assessed in 280 individuals.
Plasma folate and folic acid levels were determined using liquid chromatography-tandem mass spectrometry (LC-MS/MS) and were available for 212 patients. Treatment-related toxicities were defined as modifications such as dose reductions, changes in regimens, or early treatment discontinuation. Cox proportional dangerous regression, adjusted for age and sex, was used to analyze the associations between folate/folic acid intake, biomarkers, and treatment toxicities. The findings revealed that 53% of patients (153 individuals) encountered toxicities necessitating adjustments in capecitabine treatment.
Notably, while folate intake and plasma folate levels exhibited no significant association with treatment-related toxicities, the use of folic acid-containing supplements during treatment and the presence of folic acid in plasma, both at the time of diagnosis and during therapy—showed correlations with an increased risk of treatment-related toxicities. Specifically, the use of folic acid supplements showed a hazard ratio of 1.81 (95% confidence interval (95%CI) 1.15-2.85), while the presence of folic acid in plasma during diagnosis and treatment showed hazard ratios of 2.09 (95%CI 1.24-3.52) and 2.31 (95%CI 1.29-4.13), respectively. These findings highlight the potential link between folic acid and capecitabine-induced toxicities, emphasizing the need to investigate dietary supplement use during oncological treatments and raise awareness regarding diet-drug interactions.
Source: sciencedirect.com/science/article/abs/pii/S0002916523662951