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Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Oncol. Sep 24, 2021; 12(9): 712-724
Published online Sep 24, 2021. doi: 10.5306/wjco.v12.i9.712
Embracing cancer immunotherapy with vital micronutrients
Raymond C-F Yuen, Shiu-Ying Tsao
Raymond C-F Yuen, Department of Occupational and Family Medicine, Hosanna Clinic, Singapore 370051, Singapore
Shiu-Ying Tsao, Department of Clinical Research, Hong Kong SAR Oncology Centre, Hong Kong, China
Author contributions: Yuen RCF and Tsao SY contributed equally to this manuscript.
Conflict-of-interest statement: Both authors declare no potential conflict of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Shiu-Ying Tsao, MBBS, Academic Research, Department of Clinical Research, Hong Kong SAR Oncology Centre, Hong Kong, 46-54 Yee Wo Street, 12/F, Causeway Bay, Hong Kong SAR, China. sy_tsao@yahoo.com
Received: March 5, 2021
Peer-review started: March 5, 2021
First decision: May 4, 2021
Revised: June 16, 2021
Accepted: August 3, 2021
Article in press: August 3, 2021
Published online: September 24, 2021
Processing time: 196 Days and 3.7 Hours
Abstract

Immunotherapy is now commonly prescribed to cancer patients, but autoimmune-related adverse events are considerable. For severe, life-threatening side effects, cessation of therapy seems unavoidable, let alone intensive medical care required for patching up the adverse events. Even without serious adverse events, the response rates are too low and various combinatory regimens have been tried. However, toxicities are also added on, unless the adjuvant agents have remarkably few side effects. Actually, micronutrients are usually taken by a majority of cancer patients as nutritional support or to boost the immune function, let alone hoping to counteract treatment side effects. Recent studies have shown that combinations of micronutrients exert pleiotropic effects in controlling tumor growth and metastasis by modulating the tumor microenvironment, enhancing gut microbiota immune functions, and providing adjunct nutritional support to micronutrient deficient cancer patients. A higher than recommended dietary allowance micronutrient dose is proposed to reduce the toxic free radicals generated as a result of immunotherapy and tumor metabolism. This is not only helpful for managing treatment side effects but also enhancing treatment efficacy. As micronutrient supplementation is also useful to improve patients’ quality of life, prolong survival, and sustain compliance to immunotherapy, further investigations are mandatory.

Keywords: Immunotherapy; Micronutrients; Immune-related adverse events; Vitamins; Tumor microenvironment; Immunonutrition

Core Tip: Micronutrients in combination may enhance immunotherapy efficacy by immunomodulation and minimizing immune-related adverse events, improve acquired immune response through modification of the tumor microenvironment, enhance gut-microbiota immune functions, boost immune-nutrition function, and improve patient outcome.