Digestive tract cancer: no benefit from vitamin D?

  • Urashima M & al.
  • JAMA
  • 9 Apr 2019

  • curated by Emily Willingham, PhD
  • Univadis Clinical Summaries
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Takeaway

  • In digestive tract cancer, vitamin D3 supplementation offers no risk reduction for relapse or death from any cause.
  • Post hoc age-adjusted analysis did show benefit for relapse-free survival, but not OS.

Why this matters

  • 2 randomized trials involving vitamin D3 have yielded conflicting results, with 1 showing no protective benefit against colorectal cancer from 400 IU/day of vitamin D3 and another showing benefit with 1100 IU/day.
  • This trial involved 2000 IU/day for secondary prevention.

Key results

  • 5-year relapse-free survival: 77% with supplementation vs 69% with placebo.
  • HR for relapse or death: 0.76 (P=.18).
  • OS: 82% vs 81%.
  • HR for death: 0.95 (P=.83).
  • Among those with vitamin D, 20-40 ng/mL:
    • HR for relapse or death with supplementation vs placebo: 0.46 (P=.02; P=.04 for interaction).
  • Fracture rates: 1.3% with supplementation vs 3.4% without.
  • Urinary stones: 0.9% with supplementation vs 0% without.

Study design

  • Randomized, double-blind, placebo-controlled trial of 251 patients with gastric cancer taking vitamin D3 supplement (2000 IU/day) vs 166 in placebo group.
  • Primary outcome: relapse-free survival to relapse or death.
  • Funding: Ministry of Education, Culture, Sports, Science, and Technology, Japan; others.

Limitations

  • A mix of cancers included.

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