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Overall and Progression-Free Survival of Patients With Malignant Neoplasm Following Intravenous Vitamin C: A Systematic Review and Meta-Analysis.

  • 2025-07-01
  • International journal for vitamin and nutrition research. Internationale Zeitschrift fur Vitamin- und Ernahrungsforschung. Journal international de vitaminologie et de nutrition 95(3)
    • Jinxiu Qu
    • Mingtao Yao
    • Shijie Yu
    • Yi Wang
    • Shuai Lu
    • Bing Wang
    • Jia He
    • Shiwan Wang
    • Yuan Zhao
    • Xin Wang
    • Xiaomei Tao
    • Xiaozhu Liu
    • Yizhong Rao
    • Yuru Li
    • Benqiang Rao

Study Design

Type
Meta-Analysis
Population
adults with malignant neoplasm
Methods
Primary search of MEDLINE, Embase, and CENTRAL from inception to October 13, 2024; included randomized clinical trials and cohort studies comparing intravenous vitamin C to blank controls or placebo; two independent reviewers assessed data extraction and risk of bias; certainty of evidence evaluated using GRADE; frequentist framework for analysis
Funding
Unclear

Background

This study aimed to determine whether administering intravenous vitamin C in patients with malignant neoplasm is associated with increased survival outcomes compared to no intravenous vitamin C administration.

Methods

The primary search was conducted using MEDLINE (via PubMed), Embase, and Cochrane Central Register of Controlled Trials (CENTRAL) databases from inception to October 13, 2024. Results were collected from randomized clinical trials and cohort studies that compared intravenous vitamin C and blank controls or placebo in patients with malignant neoplasm. Two reviewers independently assessed the data extraction process and the risk of bias, while the certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. A frequentist framework was used as the primary analysis approach.

Results

A total of 8 studies with 2722 adult participants were included. The vitamin C dose ranged from 2.5 g/d to 1.5 g/kg of body weight per day, with the treatment duration ranging from 9 days to 1 year. The primary outcome was overall survival, with progression-free survival as a secondary measure. Intravenous vitamin C was associated with a significantly longer median overall survival (pooled estimated median survival ratio: 1.83; 95% confidence interval: 1.40-2.40; p < 0.001; moderate certainty), and a trend towards improved progression-free survival (pooled estimated median survival ratio: 1.80; 95% confidence interval: 0.95-3.41; p = 0.073). Subgroup analyses of overall survival showed higher median survival ratios with vitamin C doses <1 g/kg (vs. ≥1 g/kg), in non-Chinese regions (vs. Chinese regions), with non-chemotherapy combinations (vs. chemotherapy combinations), and in cohort studies (vs. randomized controlled trials).

Conclusions

The administration of intravenous vitamin C to adults with malignant neoplasm was associated with a longer median overall survival compared to no vitamin C administration. The current evidence indicates a moderate degree of certainty for considering intravenous vitamin C as a standard of care in managing malignant neoplasms. The PROSPERO Registration: CRD42024600634, https://www.crd.york.ac.uk/PROSPERO/view/CRD42024600634.

Research Insights

  • Vitamin C→Improved Overall Survival

    Intravenous vitamin C was associated with a significantly longer median overall survival (pooled estimated median survival ratio: 1.83; 95% confidence interval: 1.40-2.40; p < 0.001; moderate certainty)

    Effect
    Beneficial
    Effect size
    Large
    Dose
    2.5 g/d to 1.5 g/kg of body weight per day
  • Vitamin C→Improved Progression-free Survival

    and a trend towards improved progression-free survival (pooled estimated median survival ratio: 1.80; 95% confidence interval: 0.95-3.41; p = 0.073)

    Effect
    Neutral
    Effect size
    Small
    Dose
    2.5 g/d to 1.5 g/kg of body weight per day
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