High Dosage Vitamin C Therapy - Hong Kong
Relationship between Vitamin C and Cancer
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What is High Dosage Vitamin C ?
Generally speaking, oral vitamin C intake exceeding 2,000 mg per day is considered a high dose. The dosage for intravenous injection is usually divided into medium dose (10,000-20,000 mg), high dose (30,000-50,000 mg), and ultra-high dose (50,000-100,000 mg), which should be determined by the physician based on the individual’s physical condition and treatment purpose.
What is Vitamin C?
Vitamin C is the most important water-soluble vitamin in the human body, because it is a cofactor for various enzymes, collagen, cholesterol metabolism, and synthesis of neurotransmitters in the body. Vitamin C, also known as Ascorbic Acid, also plays an important role in the function of immune cells.
Most mammals can synthesize vitamin C from their bodies on their own, but humans cannot make it by themselves due to lack of such genes. They must get enough vitamin C from other sources (such as food/nutrition supplements). Due to the instability of vitamin C in food, storage, high temperature or over-cooking will destroy many vitamin C. Eating natural foods alone may not be able to meet daily needs, so some people choose to take vitamin C-rich nutrition supplements, or pursue high dosage vitamin c therapy.
In addition to adjuvant cancer treatment, high-dose vitamin C is also widely used in:
- Enhance immune system function
- Anti-oxidation and anti-inflammatory effects
- Assist collagen synthesis and promote wound healing
- Improve chronic fatigue and stress
- Supportive therapy to assist in the management of diabetes and cardiovascular disease
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Limitations in Oral Intake of Vitamin C
It should be noted that the human body has a very strict regulatory mechanism for the absorption of vitamin C. Therefore, despite the high oral dose of vitamin C, the concentration of vitamin C in the blood is still maintained at tens of micromoles (μmol/L), making it unable to achieve optimal results. In addition, orally intake high-dose vitamin C may cause stomach irritation, nausea, vomiting, abdominal pain and diarrhea and other gastrointestinal symptoms.
High dosage vitamin c therapy drip, which is more common in Europe and the United States, a method that supplements vitamin C through intravenous injection, allowing vitamin C to be taken directly into the blood. This method helps elevate blood concentration of vitamin C to a level that is around 100+ times higher than having oral administration of vitamin C. In addition, this method can bypass the digestive system and avoid gastrointestinal irritation, and there are no obvious side effects. Therefore, some people choose to take high dosage vitamin C through IV drip.
Differences between oral and intravenous administration
The absorption efficiency of vitamin C varies depending on how you take it. The absorption rate of oral vitamin C is limited, and as the dosage increases, the intestinal absorption capacity gradually decreases. Intravenous injection can bypass the digestive tract and enter the blood directly, rapidly increasing the concentration of vitamin C in the blood, making it more suitable for medical auxiliary treatment.
Background of High-Dosage Vitamin C Therapy (IV Vitamin C)
As early as half a century ago, vitamin C has been used to prevent common colds and scurvy (Scurvy). Dr. Linus Carl Pauling, an American chemist who won the Nobel Prize twice, discovered that high dosage vitamin c therapy has a supportive effect on the overall cancer treatment plan. He and his team discovered that not only IV Vitamin C drip has the opportunity to enhance the immunity of cancer patients and promote the health of patients, but also may help on their life expectancy. Since then, more laboratory and clinical studies have discovered that applying high dosage vitamin C in cancer treatments has the potential to reduce the division of a variety of cancer cells, reduce cancer recurrence and improve the quality of life of patients (More studies are needed to verify such claims).
Therefore, high dosage vitamin c therapy, in Hong Kong and abroad, has widely been used in integrative therapy.
High Dosage Vitamin C as Supportive Therapy
Vitamin C is an antioxidant nutrient that is beneficial to the body. It is originally an essential nutrient for the body to reduce toxins and defend against infections. In addition to the fact that IV Vitamin C Drip can help increase the level of vitamin C in the blood, studies have also discovered that having a corresponding dose of IV Vitamin C has a supportive effect on radiotherapy or chemotherapy.
High dosage vitamin C in cancer treatment, has the potential to (1) reduce the side effect in traditional treatment (including nausea, loss of appetite, fatigue, depression, insomnia, dizziness, low immunity, weakness, etc.), and (2) support cancer patients for a better life quality.
Not everyone is suitable for high-dose vitamin C therapy. The following groups are recommended to consult a doctor first:
- People with a history of kidney stones
- Patients with renal insufficiency or on dialysis
- People with hemochromatosis
- People with glucose-6-phosphate dehydrogenase deficiency (G6PD deficiency)
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Studies' viewpoints on High-Dosage Vitamin C
Different concentrations level of vitamin C have different functions in the human body. If the concentration of vitamin C in the body reaches 0.1mM, vitamin C , it could become an effective antioxidant, a molecule that can effectively slow down or prevent oxidation. At high concentrations of vitamin C, hydrogen peroxide (a type of reactive oxygen species) is produced during the breakdown of vitamin C, which can damage tissue and DNA. Normal cells have multiple pathways to remove hydrogen peroxide, keeping it low level to avoid injury. Compared with normal cells, the ability of cancer cells to remove hydrogen peroxide is relatively weak, so hydrogen peroxide may be able to destroy tumor cell tissue.
Studies have shown that tumor tissue has abnormally high levels of redox-active iron molecules (a byproduct of abnormal mitochondrial metabolism) that react with vitamin C to generate hydrogen peroxide and free radicals derived from hydrogen peroxide. These free radicals are thought to selectively cause DNA damage in cancer cells, potentially causing cancer cell death and increasing the sensitivity of cancer cells to radiation and chemotherapy.
Tumor angiogenesis is critical for tumor growth and metastasis, as it provides a nutrient supply and waste removal system. Studies have shown that high doses of vitamin C can help the synthesis of collagen, thereby strengthening the structural layer between cells, and have the opportunity to prevent cancer cells from penetrating the structural layer, thereby inhibiting the formation of new blood vessel tubules, preventing tumor growth and reducing spread. .
A study examined the clinical utility of intravenous vitamin C in terms of quality of life, conducted a prospective observational study of changes in quality of life caused by intravenous vitamin C, and evaluated its safety in cancer patients. The results showed that after 4 weeks of intravenous vitamin C treatment, the collected [Global Health Status Score] and [Functional Scale Score] showed significant improvement; in addition, subjective symptom scores, especially fatigue and insomnia scores were significantly improved . Based on these results, the study suggests that intravenous vitamin C can safely improve the quality of life of cancer patients.
A study published in Japan in 2012 showed that vitamin C drips can help improve or maintain the quality of life of cancer patients. Cancer patients who received intravenous vitamin C for 2 weeks experienced a significant reduction in the severity of some symptoms, including fatigue, insomnia, and constipation. After 4 weeks of treatment, pain began to significantly ease, and overall quality of life scores also improved significantly.
Who Shall Consider to consult a doctor for high dosage Vitamin C Therapy (IV VITAMIN C)
The following types of people may consider consulting a doctor for more information with regards to High dosage Vitamin c therapy, or for cancer treatment support:
- People with Tumor
- Cancer survivor
- Patients with chronic diseases and immune system diseases
- Patient Arthritis
Safety and possible side effects
High doses of vitamin C are relatively safe under professional medical supervision. However, the following minor side effects may still occur
The following people shall not consider having high-dosage vitamin C therapy in HK:
- Patients with glucose-hexa-phosphate dehydrogenase (G6PD) deficiency
- Patients with renal failure requiring artificial dialysis
- People who are malnourished
- People with symptoms of dehydration
- Gastrointestinal upset (especially when taken orally)
- Mild nausea or diarrhea
- Long-term high doses may increase the risk of kidney stones (requires adequate drinking and monitoring)
The following side effects may occur:
- Irritating pain at the area of injection
There may be irritating pain at the site where the drip is injected (Decreasing the drip rate can relieve symptoms. - Dry mouth
There is a chance of a diuretic bodily response to IV injections, you should drink plenty of fluids during or after your IV session. - Possibility of causing hypoglycemia
At the chemical level, vitamin C has a very similar structure to glucose, and when the infusion is in progress, the body secretes insulin, causing blood sugar to drop and hypoglycemia to occur (although this is very rare). So try to avoid Take the infusion after a meal when the stomach is full.
On a chemical level, vitamin C has a structure very similar to glucose. When the infusion is in progress, the body will secrete insulin, causing blood sugar to drop and hypoglycemia to occur (but this is extremely rare). Therefore, it is best to receive the infusion after a meal with a full stomach.
It is recommended that a doctor assess the physical condition before the treatment and follow up regularly during the treatment.
Notes:
Research Update on High Dosage Vitamin C:
Several studies have shown that high doses of vitamin C have potential anti-cancer properties. According to the National Cancer Institute (NCI) of the United States, high concentrations of vitamin C may produce reactive oxygen species that selectively kill cancer cells while causing less damage to normal cells. In addition, some studies have shown that it can reduce the side effects of chemotherapy and improve the quality of life.
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FAQ - High Dosage Vitamin C Therapy
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What is the cost of high-dose vitamin C?
The cost of high-dose vitamin C varies across different countries. In Hong Kong, the price ranges from HK$2,500 to HK$3,500 per session (varies by dosage), typically charged in a treatment course of 10-session.
What should be noted when receiving intravenous high-dose vitamin C injections?
Due to the fact that the administration of high-dose vitamin C injections is a procedure that requires supervision by healthcare professionals, it must be conducted by qualified medical personnel to ensure the accuracy of infusion and the safety of the process.
Conventional treatment vs. high-dose vitamin C therapy?
High-dose vitamin C Therapy cannot replace traditional/conventional mainstream treatments such as chemotherapy, radiation therapy, cellular therapy, or immunotherapy. It is important to consult with your doctor to plan an appropriate adjunctive treatment plan and to coordinate with the treatment plan of mainstream conventional medicine.
Protocol of high dosage vitamin C?
The recommended dosage, duration, and frequency of treatment may vary depending on the individual’s condition and tolerance.
Typically, a single infusion of high-dose vitamin C ranges from 300ml to 500ml, and the administration time is approximately 60 to 90 minutes.
After diagnosis, the doctor will advise on the appropriate dosage, duration, and frequency of treatment.
Benefits of high-dose vitamin C?
High-dose vitamin C therapy can enhance immune function, and there are studies suggesting a potential reduction in the risk of developing cancer or its spread (further research is needed). It may also contribute to improving the effectiveness of chemotherapy and radiation therapy (further research is needed). Cancer patients, individuals in recovery, those with chronic diseases, or immune system disorders can consult with healthcare professionals and doctors to learn more about this treatment method.
Can high-dose IV Vitamin C extend survival for cancer patients?
Some overseas clinical studies suggest that high-dose IV Vitamin C, when used as supportive care alongside standard chemotherapy, may offer potential survival benefits in specific cancers (e.g., advanced pancreatic cancer). For example, a 2024 randomized phase II trial from the University of Iowa (a small study involving 34 patients with late-stage metastatic pancreatic cancer) reported that adding high-dose IV Vitamin C to chemotherapy extended median overall survival from about 8 months to 16 months, while also improving quality of life and reducing certain side effects. However, this is a single phase II result and has not been confirmed by large-scale phase III trials or broad consensus for reliably extending survival across all cancer types or patient groups. Hong Kong currently has no official research, clinical trials, or guidelines endorsing this as a standard approach for survival extension. Reviews from sources like the NCI and Mayo Clinic note possible benefits in treatment tolerance, but there is no evidence it cures cancer or dramatically improves prognosis on its own. At BMS Clinic, all IVC sessions are strictly supervised by registered doctors, with pre-screening (e.g., kidney function, G6PD deficiency) and coordination with your primary oncologist (Upon request) to ensure safety and avoid conflicts. It is suitable only as complementary support, not a replacement for mainstream treatment. Appropriate for patients in Cheung Sha Wan and Hong Kong—bring your medical records for a consultation: +852 2370 3001 or WhatsApp +852 9277 7808.
Is high-dose IV Vitamin C safe for cancer treatment? What are the potential side effects?
Under professional medical supervision, high-dose IV Vitamin C is generally safe and well-tolerated. Clinical trials (e.g., Mayo Clinic, NCI, and recent pancreatic cancer studies) show most patients experience no serious adverse events. Common mild side effects include minor discomfort at the IV site, dry mouth, slight nausea, or temporary blood sugar fluctuations (as IVC can interfere with some glucose tests). We pre-screen for risks like kidney function or G6PD deficiency to prevent complications. At BMS Clinic in Cheung Sha Wan, Hong Kong, we follow strict safety protocols for outpatient sessions. Suitable for most patients after individual assessment.
Does high dose vitamin C cure cancer?
No, high-dose vitamin C does not cure cancer on its own, and there is no reliable evidence that it serves as a standalone cure for any type of cancer.
High-dose intravenous vitamin C (HDIVC, also known as pharmacological ascorbate) is best studied and utilized as a supportive adjunctive therapy in integrative oncology. Many experienced integrative doctors incorporate it alongside standard cancer treatments (such as chemotherapy, radiation, or immunotherapy) to help enhance treatment tolerance, support quality of life, and potentially improve clinical outcomes for suitable patients.
Recent evidence is encouraging in this supportive role:
- A randomized Phase II clinical trial published in Redox Biology (2024) from the University of Iowa showed that adding high-dose IV vitamin C (75 g, three times per week) to standard chemotherapy (gemcitabine + nab-paclitaxel) in patients with stage IV metastatic pancreatic cancer nearly doubled median overall survival — from approximately 8 months with chemotherapy alone to 16 months with the combination. Progression-free survival also improved, and the addition was well tolerated without increasing severe side effects or harming quality of life.
Other Phase I/II studies and reviews have similarly reported benefits when HDIVC is used supportively, including:
- Reduced fatigue, pain, and nausea
- Better tolerance to chemotherapy and radiation
- Potential protective effects on healthy tissues while exerting selective oxidative stress on cancer cells
Integrative doctors with expertise in this area often emphasize proper patient selection, precise dosing, and integration with conventional care to maximize these supportive benefits. Larger Phase III trials are ongoing to further clarify its role across different cancer types.
Key takeaway: High-dose IV vitamin C is not a cancer cure, but when thoughtfully incorporated by experienced integrative practitioners as part of a comprehensive plan, it shows promise as a safe, well-tolerated supportive option that may help improve survival and quality of life in certain settings. It should always complement — never replace — standard oncology care. Patients are encouraged to discuss it openly with a qualified doctor for personalized guidance.
Why does high dose IV vitamin C work for some cancer patients but not others?
The effectiveness of high-dose intravenous vitamin C (HDIVC) as a supportive therapy can vary noticeably between patients. This difference does not mean the approach is ineffective overall; rather, it often reflects how precisely the therapy is tailored to the individual — an area where experienced integrative doctors can make a meaningful difference.
Skilled integrative oncology practitioners focus on optimizing several key factors to improve the likelihood of benefit:
Precise Dosage and Plasma Levels Benefits are linked to achieving high pharmacological blood concentrations (typically >10 mM), which only intravenous administration can reliably deliver. Integrative doctors carefully calculate and monitor doses to ensure therapeutic levels are reached safely.
Frequency, Duration, and Timing Effective protocols commonly involve 2–3 infusions per week over an extended period, carefully timed with other treatments for better synergy.
Integration with Standard Therapies Many integrative doctors report stronger supportive effects when HDIVC is thoughtfully combined with specific chemotherapies, radiation, or immunotherapy, potentially enhancing tolerance and outcomes while helping protect normal cells.
Comprehensive Patient Assessment Experienced practitioners perform thorough screening (e.g., G6PD deficiency, kidney function) and consider the patient’s overall health, cancer stage, and individual biology.
Personalized Sensitivity Profiling One helpful emerging tool used in some integrative settings is Circulating Tumor Cell (CTC) functional sensitivity testing. This lab analysis exposes a patient’s own circulating cancer cells to high-dose vitamin C (and other natural substances) to assess likely response.
- High sensitivity on the test may indicate a greater chance of benefit from HDIVC.
- Low sensitivity helps guide the doctor toward more suitable supportive options.
This type of personalization allows integrative doctors to move beyond generic approaches and design regimens better matched to the patient’s unique cancer biology.
Bottom line: When administered with attention to detail by integrative doctors experienced in adjunctive therapies, high-dose IV vitamin C can provide meaningful supportive benefits for many patients — including better quality of life and, in some cases, improved survival metrics as seen in recent trials. Results are more consistent when the therapy is precisely executed and integrated into a broader, individualized care plan.
Important Safety Note: Under proper medical supervision with appropriate screening, HDIVC has demonstrated a good safety profile in clinical studies. It is intended as a complementary supportive approach, not a replacement for conventional cancer treatment. The best outcomes often occur through close collaboration between the patient’s oncologist and an experienced integrative doctor.
Disclaimer: This information is for educational purposes only and is not medical advice. Treatment decisions, including the use of any integrative therapies, should always be made in consultation with qualified healthcare professionals based on your individual situation.
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References
Research studies from 1974–1978 showing the beneficial effects of intravenous vitamin C therapy on cancer:
- Cameron E, Campbell A. The orthomolecular treatment of cancer. ii. Clinical trial of high-dose ascorbic acid supplements in advanced human cancer. Chem Biol Interact. 1974;9:285–315. doi: 10.1016/0009-2797(74)90019-2.
- Cameron E., Pauling L. (1976). Supplemental ascorbate in the supportive treatment of cancer: prolongation of survival times in terminal human cancer. Proc. Natl. Acad. Sci. U.S.A. 73 3685–3689. 10.1073/pnas.73.10.3685
- Cameron E, Pauling L. Supplemental ascorbate in the supportive treatment of cancer: reevaluation of prolongation of survival times in terminal human cancer. Proc Natl Acad Sci U S A. 1978;75:4538–42. doi: 10.1073/pnas.75.9.4538.
Clinical trials and related studies demonstrating the safety of intravenous vitamin C therapy:
- Riordan HD, Casciari JJ, González MJ, et al. A pilot clinical study of continuous intravenous ascorbate in terminal cancer patients. P R Health Sci J. 2005;24:269–76.
- Hoffer LJ, Levine M, Assouline S, et al. Phase i clinical trial of i.v. ascorbic acid in advanced malignancy. Ann Oncol. 2008;19:1969–74. doi: 10.1093/annonc/mdn377. [Erratum in: Ann Oncol 2008;19:2095]
- Monti DA, Mitchell E, Bazzan AJ, et al. Phase i evaluation of intravenous ascorbic acid in combination with gemcitabine and erlotinib in patients with metastatic pancreatic cancer. PLoS One. 2012;7:e29794. doi: 10.1371/journal.pone.0029794.
- Welsh JL, Wagner BA, van’t Erve TJ, et al. Pharmacological ascorbate with gemcitabine for the control of metastatic and node-positive pancreatic cancer (pacman): results from a phase i clinical trial. Cancer Chemother Pharmacol. 2013;71:765–75. doi: 10.1007/s00280-013-2070-8.
- Stephenson CM, Levin RD, Spector T, Lis CG. Phase i clinical trial to evaluate the safety, tolerability, and pharmacokinetics of high-dose intravenous ascorbic acid in patients with advanced cancer. Cancer Chemother Pharmacol. 2013;72:139–46. doi: 10.1007/s00280-013-2179-9.
- Ma Y, Chapman J, Levine M, Polireddy K, Drisko J, Chen Q. High-dose parenteral ascorbate enhanced chemosensitivity of ovarian cancer and reduced toxicity of chemotherapy. Sci Transl Med. 2014;6:222ra18. doi: 10.1126/scitranslmed.3007154.
Case reports of kidney stone formation in patients with kidney disease following intravenous vitamin C administration:
- Riordan H. D., Casciari J. J., Gonzalez M. J., Riordan N. H., Miranda-Massari J. R., Taylor P., et al. (2005). A pilot clinical study of continuous intravenous ascorbate in terminal cancer patients. PR Health Sci. J. 24 269–276.
- Lawton J. M., Conway L. T., Crosson J. T., Smith C. L., Abraham P. A. (1985). Acute oxalate nephropathy after massive ascorbic acid administration. Arch. Intern. Med. 145 950–951. 10.1001/archinte.1985.00360050220044
- Wong K., Thomson C., Bailey R. R., McDiarmid S., Gardner J. (1994). Acute oxalate nephropathy after a massive intravenous dose of vitamin C. Aust. N. Z. J. Med. 24 410–411. 10.1111/j.1445-5994.1994.tb01477.x
- Cossey L. N., Rahim F., Larsen C. P. (2013). Oxalate nephropathy and intravenous vitamin C. Am. J. Kidney Dis. 61 1032–1035. 10.1053/j.ajkd.2013.01.025
Prospective studies showing that vitamin C does not cause kidney stones:
- Curhan GC, Willett WC, Speizer FE, Stampfer MJ. Intake of vitamins B6 and C and the risk of kidney stones in women. J Am Soc Nephrol. 1999;10:840–5.
- Gerster H. No contribution of ascorbic acid to renal calcium oxalate stones. Ann Nutr Metab. 1997;41:269–82. doi: 10.1159/000177954.
- Curhan G.C., Willett W.C., Rimm E.B., Stampfer M.J. A prospective study of the intake of vitamins C and B6, and the risk of kidney stones in men. J Urol. 1996;155:1847–1851.
Two studies from Mayo Clinic showing that oral vitamin C was ineffective against cancer:
- Creagan E. T., Moertel C. G., O’Fallon J. R., Schutt A. J., O’Connell M. J., Rubin J., et al. (1979). Failure of high-dose vitamin C (ascorbic acid) therapy to benefit patients with advanced cancer. A controlled trial. N. Engl. J. Med. 301 687–690. 10.1056/NEJM197909273011303
- Moertel C. G., Fleming T. R., Creagan E. T., Rubin J., O’Connell M. J., Ames M. M. (1985). High-dose vitamin C versus placebo in the treatment of patients with advanced cancer who have had no prior chemotherapy. A randomized double-blind comparison. N. Engl. J. Med. 312 137–141. 10.1056/NEJM198501173120301
A series of studies published by the Proceedings of the National Academy of Sciences (PNAS) since 2005:
- Chen Q, Espey MG, Krishna MC, et al. Pharmacologic ascorbic acid concentrations selectively kill cancer cells: action as a pro-drug to deliver hydrogen peroxide to tissues. Proc Natl Acad Sci U S A. 2005;102(38):13604-13609. doi:10.1073/pnas.0506390102
- Chen Q, Espey MG, Sun AY, et al. Ascorbate in pharmacologic concentrations selectively generates ascorbate radical and hydrogen peroxide in extracellular fluid in vivo. Proc Natl Acad Sci U S A. 2007;104(21):8749-8754. doi:10.1073/pnas.0702854104
- Chen Q, Espey MG, Sun AY, et al. Pharmacologic doses of ascorbate act as a prooxidant and decrease growth of aggressive tumor xenografts in mice. Proc Natl Acad Sci U S A. 2008;105(32):11105-11109. doi:10.1073/pnas.0804226105
Intravenous vitamin C therapy improving survival time in cancer patients and promoting regression of advanced cancers… Some encouraging small-scale studies:
- Mikirova N, Hunnunghake R, Scimeca RC, et al. High-dose intravenous vitamin C treatment of a child with neurofibromatosis type 1 and optic pathway glioma: a case report. Am J Case Rep. 2016;17:774–81. doi: 10.12659/AJCR.899754.
- Murata A., Morishige F., Yamaguchi H. (1982). Prolongation of survival times of terminal cancer patients by administration of large doses of ascorbate. Int. J. Vitam Nutr. Res. Suppl. 23 103–113.
- Zhao H., Zhu H., Huang J., Zhu Y., Hong M., Zhu H., et al. (2018). The synergy of vitamin C with decitabine activates TET2 in leukemic cells and significantly improves overall survival in elderly patients with acute myeloid leukemia. Leuk Res. 66 1–7. 10.1016/j.leukres.2017.12.009
- Gunes-Bayir A., Kiziltan H. S. (2015). Palliative vitamin C application in patients with radiotherapy-resistant bone metastases: a retrospective study. Nutr. Cancer 67 921–925. 10.1080/01635581.2015.1055366
- Schoenfeld J. D., Sibenaller Z. A., Mapuskar K. A., Wagner B. A., Cramer-Morales K. L., Furqan M., et al. (2017). O2- and H2O2-Mediated Disruption of Fe metabolism causes the differential susceptibility of NSCLC and GBM Cancer cells to pharmacological ascorbate. Cancer Cell. 31 487.e8–500.e8. 10.1016/j.ccell.2017.02.018
- Padayatty S. J., Riordan H. D., Hewitt S. M., Katz A., Hoffer L. J., Levine M. (2006). Intravenously administered vitamin C as cancer therapy: three cases. CMAJ 174 937–942. 10.1503/cmaj.050346
- Raymond Y. C., Glenda C. S., Meng L. K. (2016). Effects of high doses of vitamin C on cancer patients in singapore: nine cases. Integr. Cancer Ther. 15 197–204. 10.1177/1534735415622010