Folate, folic acid, and chemotherapy-induced toxicities: A systematic literature review
N. Zwart, Mira D. Franken, Wim J. E. Tissing, Floor J.E. Lubberman, Jill A. McKay, Ellen Kampman, Dieuwertje E. Kok
Abstract
Folate metabolism is a target for various chemotherapeutic drugs. Folate and its synthetic variant folic acid are B-vitamins. To what extent these vitamins impact treatment tolerance in patients with cancer remains unclear. A systematic literature review was conducted on intake and status of folate and folic acid in relation to chemotherapy-induced toxicities in children and adults with cancer. A total of 6231 publications were identified, of which 40 publications met the inclusion criteria. In 12 out of 22 studies focusing on antifolates, a deficient folate status and lower folate and folic acid intake were associated with a higher risk of toxicities. In 8 out of 14 studies focusing on fluoropyrimidine treatments, a higher folate status and intake were associated with a higher risk of toxicities. These findings might explain interindividual differences in treatment tolerance and highlight the importance of evaluating nutritional status in oncology care. • Folate and folic acid are associated with chemotherapy-induced toxicities. • Deficient folate status associated with higher risk of antifolate toxicities. • Higher folate status associated with higher risk of fluoropyrimidine toxicities. • Clinical practice may start looking at personalized dosing based on nutrient status.