folate vs folic acid supplementation before chemo?

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This topic contains 10 replies, has 4 voices, and was last updated by  kempten 1 year, 1 month ago.

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September 28, 2016 at 8:30 am  #1288771    

kempten

Hello

I have a question concerning Folic Acid supplementation before Carboplatin/ Alimta therapy.
I already checked your archive but did not find a specific answer to my question.

Question:
Is it ok to take folate supplements in its natural form instead of the synthetic folic acid ?

I found this excerpt about high folic acid intake and existing cancer and was wondering if this is something to worry about.

These findings, combined with evidence from laboratory and animal studies indicating that high folate status promotes tumor progression, suggest that folate might play dual roles in the risk of colorectal cancer, and possibly other cancers, depending on the dosage and timing of the exposure. Modest doses of folic acid taken before preneoplastic lesions are established might suppress the development of cancer in normal tissues, whereas high doses taken after the establishment of preneoplastic lesions might promote cancer development and progression [37-39]. This hypothesis is supported by a 2011 prospective study that found an inverse association between folate intake and risk of colorectal cancer only during early preadenoma stages [40].

Is there any evidence that folate might not have the same tumor promoting affect that synthetic folic acid has ?
Thanks
Kempten

September 28, 2016 at 11:53 am  #1288775    
catdander forum moderator
catdander forum moderator

Kempten,

That’s a fair question. Dr. West reminds us that studies show supplementation with B12 and folic acid (in appropriate doses) provide the needed protection to healthy cells while still allowing alimta to provide anticancer efficacy.

Dr. West states, “Normal, non-cancer cells can be “rescued” from the damaging effects of Alimta (pemetrexed) with the addition of B12 and folate, while cancer cells don’t tend to be able to pick up and be rescued by these doses and are preferentially damaged vs. normal cells. The addition of these supplements has been associated with a decrease in side effects with Alimta, without a perceptible effect on efficacy. However, there is reason to be concerned that at high doses of B12 and/or folate (higher than the well defined recommendations for use with Alimta), you could lose the selective effect on cancer cells vs. normal cells and actually rescue cancer cells as well.” http://cancergrace.org/forums/index.php?topic=7846.0

Supplementation taken from natural sources can’t provide the exact dosing that folic acid supplements can provide, there are too many variables to be sure of proper dosing.

Another thread not specific to natural intake of folate but does speak to rather high dosing of folic acid. http://cancergrace.org/forums/index.php?topic=6690.0

To make sure your question is answered as well as possible I’ll ask Dr. Walko to comment.

Best of luck on the new regimen!

Janine

September 28, 2016 at 3:46 pm  #1288779    

kempten

Hello Janine,
thank you for your answer . I did actually find the above passage from Dr Wests explanation in my pre posting search.
I found this very educational.
I am supposed to take 1 mg daily. Is this the regular pre chemo dose? I saw other chemo regiments with lower dosages( 350mcg/400mcg up to 1 000mcg ). Would the lower dose be sufficient?
Is there any evidence that patients might progress faster during the premedication stage, during which period chemo has not been started yet?

thanks again
Kempten

September 28, 2016 at 5:40 pm  #1288780    
JimC Forum Moderator
JimC Forum Moderator

Hi Kempten,

The Alimta prescribing information states:

“To reduce toxicity, patients treated with ALIMTA must be instructed to take a low-dose oral folic acid preparation or multivitamin with folic acid on a daily basis. At least 5 daily doses of folic acid must be taken during the 7-day period preceding the first dose of ALIMTA; and dosing should continue during the full course of therapy and for 21 days after the last dose of ALIMTA. Patients must also receive one (1) intramuscular injection of vitamin B12 during the week preceding the first dose of ALIMTA and every 3 cycles thereafter. Subsequent vitamin B12 injections may be given the same day as ALIMTA. In clinical trials, the dose of folic acid studied ranged from 350 to 1000 mcg, and the dose of vitamin B12 was 1000 mcg. The most commonly used dose of oral folic acid in clinical trials was 400 mcg.”http://www.accessdata.fda.gov/drugsatfda_docs/label/2008/021462s015lbl.pdf (Section 2.3)

As with most dosage recommendations of this sort, it’s not known what specific dose will be sufficient for a particular patient, but since the clinical trial evidence often shows efficacy in reducing side effects at 400 mcg, that would probably work for most patients. If side effects do appear, raising the folic acid dosage would be an option.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

September 28, 2016 at 5:48 pm  #1288783    
JimC Forum Moderator
JimC Forum Moderator

Hi Kempten,

Just to add that in this post Dr. West states that he recommends a 400 mcg dose to his patients.

JimC
Forum moderator


Jul 2008 Wife Liz (51/never smoker) Dx Stage IV NSCLC EGFR exon 19
4 cycles Carbo/alimta, 65% shrinkage
Tarceva maintenance
Mar 2010 progression, added Alimta, stable
Sep 2010 multiple brain mets, WBR
Oct 2010 large pericardial effusion, tamponade
Jan 2011 progression, start abraxane
Jun 2011-New liver, brain mets, add Tarceva
Oct 2011-Dx Leptomeningeal carcinomatosis; pulsed Tarceva
At rest Nov 4 2011
Since then: http://cancergrace.org/blog/jim-and-lisa

September 28, 2016 at 5:49 pm  #1288785    

kempten

thank you Jim
Kempten

September 29, 2016 at 5:16 am  #1288789    

cards7up

I was going to say that I took the 400mcg and had a B12 shot every 9 weeks, which would be every 3 cycles.
Then I took it for a month after completing carbo/alimta. Since you have another chemo drug along with the alimta, I wouldn’t worry about folic acid intake as it is low compared to what most articles talk about pertaining to cancer. Take care, Judy


Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011.
Local recurrence, surgery to remove LRL 8/29/13. 5.2cm involved pleura. Chemo carbo/alimta x3. NED

September 29, 2016 at 6:23 am  #1288792    

kempten

Thanks again everyone for your information

I’m sorry to bug you all again.
Would taking 5methyl THF ( the more natural form ) be ok to take. It does come in the same strengths as the synthetic Folic Acid supplements and according to some studies the absorption is comparable.
It has the advantage to be better for the 40% of the population who have a polymorphism in genes related to folate metabolism and absorption

thanks
Kempten

September 29, 2016 at 11:50 am  #1288795    
catdander forum moderator
catdander forum moderator

Interesting question Kempten. We’ll see if an onc or onc pharm will have input. My daily vitamins use the 5methyl THF form.

September 30, 2016 at 5:01 am  #1288802    

cards7up

This article may clarify somewhat. Take care, Judy
https://www.ncbi.nlm.nih.gov/pubmed/20608755


Stage IIIA adeno, dx 7/2010. SRS then chemo carbo/alimta 4x. NED as of 10/2011.
Local recurrence, surgery to remove LRL 8/29/13. 5.2cm involved pleura. Chemo carbo/alimta x3. NED

September 30, 2016 at 7:08 am  #1288803    

kempten

Thank you Judy,
the study you mentioned is the one I based my question on.
It is possible , I guess , that preventing neural tube defects in embryos and salvaging healthy cells from chemo toxicity might call for completely different approaches. Maybe the more natural form of the vitamin would not be as effective in this specific setting when it comes to antifolates?
The folic acid metabolic cycle seems to have this paradox build in and I’m not sure if the more natural form of the supplement has ever been studied in this context?

Kempten

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