Written by Helen Cooke, Helen Seers and the CAM-Cancer Consortium.
Updated September 21, 2011

Co-enzyme Q10

Does it work?

Does CoQ10 work as an anti-cancer agent?

Controlled clinical studies

Italian researchers who conducted a three year (non-randomised) study with a sample of melanoma patients (n=81) found that the group treated with CoQ10 alongside interferon reported improved quality of life (favourable mood effects, reduction in physical weakness and in the severity of tinnitus) compared to the control group who received interferon only. The patients with stage II melanoma in this group also appeared to have a lower rate of recurrence. Further trials with more patients are being undertaken by this research team 46.The same researchers concluded that plasma CoQ10 levels are a powerful and independent prognostic factor and can be used to estimate the risk for melanoma progression 47. A trial by a team of Indian researchers using CoQ10 in a group of women (n=210) undergoing tamoxifen treatment reported reduced levels of angiogenesis markers 39.

Uncontrolled clinical studies

One uncontrolled study in Denmark followed the progress of 32 people with breast cancer for 18 months who were given antioxidant supplements including CoQ10 after or concomitantly with conventional anticancer treatment 12. At the end of this period, six people were in remission and all of the 32 were alive and reporting improved quality of life, less painkiller use and less weight loss. In a follow-up study, all 32 people were alive at 24 months 13.

Case reports

In a different study conducted by the same researchers, three people with breast cancer and taking high doses of CoQ10 were investigated for three to five years 14. All three experienced remission.

A case history review documented anecdotal reports of CoQ10 suggesting a positive survival effect on people with different cancers 11.

Overall there is no evidence to support CoQ10 working as an anti-cancer agent. The above controlled trials 39,46-47 were not high-quality randomised clinical trials and in the uncontrolled clinical studies and case reports 12-14 control groups were not used, patients were also taking supplements other than CoQ10, and effective anticancer treatments were also given.

Clinical trials of analogues of CoQ10 and CoQ10 combination products

Trials in which CoQ10 is used as part of a supplement combination appears to show some anti-cancer benefit 36-38 and improved blood chemistry profile 40-42, although an earlier trial did not show benefit 35.

Pre-clinical studies

There is some preliminary evidence from laboratory and animal studies that chemicals very similar to CoQ10 (analogues of CoQ10) 9-10 and CoQ10 used as part of an antioxidant combination 43-45 have anti-cancer effects.

Does CoQ10 work as a protector against adverse effects of chemotherapeutic agents?

Reviews

A Cochrane systematic review reported that no definite conclusions can be made about the efficacy of different cardioprotective agents for cancer patients receiving anthracyclines 48. It only included one study on CoQ10, however, that is reported below by Iarussi et al. 23.

A 2008 review by Nicolson and Conklin stated that, although limited in number, clinical studies support pre-clinical data that suggests CoQ10 protects the heart from the cardiotoxicity of anthracyclines. They noted that the impact of CoQ10 on the anti-neoplastic efficacy of anthracycline-based chemotherapy has not yet been studied 49.

A review by Roffe et al. 18 states that there is some evidence of a protective benefit from CoQ10, however, the authors conclude that the studies reviewed are all methodologically flawed and the results not conclusive. The article reviewed several pre-clinical and clinical studies, although the numbers of people included in the clinical studies were small (maximum n=80), so the results need to be interpreted with caution. The review stated that many unanswered questions remain about the use of CoQ10 alongside anthracycline. Little is known about how long these effects can last for or the best way to administer CoQ10 (what levels should be taken/should it be administered with food etc). Most importantly, little is still known about how it may affect the anti-tumour activity of anthracycline 51.

Bryant et al. conducted a systematic review to evaluate technologies to reduce anthracycline-induced cardiotoxicity in children. The review presented the results of one study that reported a protective effective of CoQ10 on cardiac function 52.

Controlled clinical trials

Several trials have looked at whether CoQ10 protects against chemotherapy induced cardiotoxicity.

Takimoto et al. 19 conducted a small randomised clinical trial (n = 40) on lung, breast and thyroid patients treated with doxorubicin chemotherapy. The experimental group was given CoQ10 and the patients were found to have improved heart capacity compared to the control group. However, no significant difference in arrhythmia frequency or other indicators of heartbeat malfunction were seen.

Akihama et al. 20 also conducted a small (n = 19) placebo-controlled, double-blind study with leukaemia and lymphoma patients taking anthracycline and also CoQ10 in the experimental group. No significant difference between control and experimental groups was found.

In another randomised clinical trial, Okuma et al. 21 studied a relatively large group of participants (n = 80) with a range of different cancers. They found CoQ10 had a significant stabilising effect on the heart.

In 1986, Lucarelli et al. 22 found CoQ10 to have a beneficial effect against anthracycline cardiotoxicity in a controlled clinical trial with 30 haematological cancer patients. This small study did, however, not report any statistics for any significant effects.

Iarussi et al. 23 conducted a small randomised clinical trial (n = 20) to look at the protective effect of CoQ10 in leukaemia and lymphoma patients’ heart function. They found less heart damage for the CoQ10 group, but crucially did not report any statistics for this, thereby not demonstrating whether CoQ10 had a therapeutic effect This study has further methodological limitations; both the participants and the providers were not blinded to the treatment 48.

Pre-clinical data

Animal evidence supporting the cardioprotective effects of CoQ10 has been seen on the heart muscles of mice, rats and rabbits given chemotherapy (Adriamycin) 15 and Doxorubicin 58. However, the same positive benefit was not found in another study with Adriamycin 16 and also radiotherapy 17. A further mice study concluded that CoQ10 ameliorated acute cystoplatin nephrotoxicity 59.

It therefore appears that although there is some evidence that CoQ10 works as a protector against adverse effects of several chemotherapeutic drugs, further higher quality trials are still needed to confirm this.

Citation

Helen Cooke, Helen Seers, CAM-Cancer Consortium. Co-enzyme Q10 [online document]. http://www.cam-cancer.org/layout/set/print/CAM-Summaries/Dietary-approaches/Co-enzyme-Q10. September 21, 2011.

Document history

Most recent revision and update in September 2011 by Helen Cooke.
Fully revised and updated in August 2009 by Helen Cooke.
First published in 2005, authored by by Helen Seers and Helen Cooke.

References

  1. Folkers, K, Osterborg, A, Nylander, M, Morita, M, & Mellstedt, H. Activities of vitamin Q10 in animal models and a serious deficiency in patients with cancer. Biochemical and Biophysical Research Communications. 1997; 234 (2): 296-9.
  2. Frei B, Kim MC, Ames BN. Ubiquinol-10 is an effective lipid-soluble antioxidant at physiological concentrations. Proceedings of the Natural Academy of Science.1990; 87(12):4879-83.
  3. Folkers, K, Shizukuishi, S, Takemura, K, Drzewoski, J, Richardson, P, Ellis, J, & Kuzell, WC. Increase in levels of IgG in serum of patients treated with coenzyme Q10. Research Communication in Chemical Patholology and Pharmacology. 1982; 38 (2): 335-8.
  4. Ernster, L, & Forsmark-Andrée, P. Ubiquinol: an endogenous antioxidant in aerobic organisms. Clinical Investigator. 1993; 71 (8 Suppl): S60-5.
  5. Lass A, Kwong L, Sohal RS. Mitochondrial coenzyme Q content and aging. Biofactors.1999; 9(2-4):199-205.
  6. Coenzyme Q10 PDQ. National Cancer Institute. [online]. 20011 [cited 20011 Aug 14]. Available from: URL http://www.cancer.gov/cancertopics/pdq/cam/coenzymeQ10/healthprofessional/allpages
  7. Jellin, JM., (Ed). Natural Medicines Comprehensive Database. 2003; Stockton, California: Therapeutic Research Faculty.
  8. Damkier A, Jensen AB, Rose C. Use of Q10 in cancer patients. Ugeskr Laeger. 1994, 7;156(6):813-8.
  9. Folkers, K. The potential of coenzyme Q 10 (NSC-140865) in cancer treatment. Cancer Chemotherapy Reports. 1974; 24 (4): 19-22.
  10. Folkers, K, Porter, TH, Bertino, JR, & Moroson, B. Inhibition of two human tumor cell lines by antimetabolites of coenzyme Q10. Research Communication in Chemical Pathology and Pharmacology. 1978; 19 (3): 485-90.
  11. Folkers, K, Brown, R, Judy, WV, & Morita, M. Survival of cancer patients on therapy with coenzyme Q10. Biochemical and Biophysical Research Communications. 1993; 192 (1): 241-5.
  12. Lockwood, K, Moesgaard, S, Hanioka, T, & Folkers, K. Apparent partial remission of breast cancer in 'high risk' patients supplemented with nutritional antioxidants, essential fatty acids and coenzyme Q10. Molecular Aspects of Medicine. 1994; 15 (Suppl): s231-40.
  13. Lockwood, K, Moesgaard, S, & Folkers, K. Partial and complete regression of breast cancer in patients in relation to dosage of coenzyme Q10. Biochemical and Biophysical Research Communications. 1994; 199 (3): 1504-8.
  14. Lockwood, K, Moesgaard, S, Yamamoto, T, & Folkers, K. Progress on therapy of breast cancer with vitamin Q10 and the regression of metastases. Biochemical and Biophysical Research Communications. 1995; 212 (1): 172-7.
  15. Shinozawa, S, Gomita, Y, & Araki, Y. Protective effects of various drugs on adriamycin (doxorubicin)-induced toxicity and microsomal lipid peroxidation in mice and rats. Biological and Pharmaceutical Bulletin. 1993; 16 (11): 1114-7.
  16. Shaeffer, J, El-Mahdi. AM, & Nichols, RK. Coenzyme Q10 and adriamycin toxicity in mice. Research Communication in Chemical Patholology and Pharmacology. 1980; 29 (2): 309-15.
  17. Lund, EL, Quistorff, B, Spang-Thomsen, M, & Kristjansen, PE. Effect of radiation therapy on small-cell lung cancer is reduced by ubiquinone intake. Folia Microbiologica (Praha). 1998; 43 (5): 505-6.
  18. Roffe, L, Schmidt, K, & Ernst, E. Efficacy of coenzyme Q10 for improved tolerability of cancer treatments: a systematic review. Journal of Clinical Oncology. 2004; 1;22 (21): 4418-24.
  19. Takimoto, M, Sakurai, T, Kodama, K, Yokoi, H, Suzuki, Y, Enomoto, K, & Okada, N. Protective effect of CoQ10 administration on cardiac toxicity in FAC therapy. Gan To Kagaku Ryoho. 1982; 9(1): 116-21.
  20. Akihama, T, Nakamoto, Y, Shindo, T, Nakayama, Y, & Miura, A. Protective effects of coenzyme Q10 on the adverse reactions of anthracycline antibiotics: using double blind method--with special reference to hair loss] Gan To Kagaku Ryoho. 1983; 10(10): 2125-9.
  21. Okuma, K, Furuta, I, & Ota, K. Protective effect of coenzyme Q10 in cardiotoxicity induced by adriamycin. Gan To Kagaku Ryoho. 1984; 11(3): 502-8.
  22. Lucarelli, G, Angelucci, C, Giardini, G. et al. Ubidecarenone and toxic cardiopathy from antiblastic therapy with daunoblastine. Boll Chim Farm. 1986; 125: S34-S39.
  23. Iarussi, D, Auricchio, U, Agretto, A, Murano, A, Giuliano, M, Casale, F, Indolfi, P, & Iacono, A. Protective effect of coenzyme Q10 on anthracyclines cardiotoxicity: control study in children with acute lymphoblastic leukemia and non-Hodgkin lymphoma. Molecular Aspects of Medicine. 1994; 15 (Suppl): s207-12.
  24. Thibault, A, Samid, D, Tompkins, AC, Figg, WD, Cooper, MR, Hohl, RJ, Trepel, J, Liang, B, Patronas, N, Venzon, DJ, Reed, E, & Myers, CE. Phase 1 study of lovastatin, an inhibitor of the mevalonate pathway, in patients with cancer. Clinical Cancer Research. 1996; 2: 483-91.
  25. Villalba JM, Parrado C, Santos-Gonzalez M, Alcain FJ, Villalba JM, Parrado C et al. Therapeutic use of coenzyme Q10 and coenzyme Q10-related compounds and formulations. [Review] [211 refs]. Expert Opinion on Investigational Drugs 2010; 19(4):535-554.
  26. Baggio, E, Gandini, R, Plancher, AC, Passeri, M, & Carmosino, G. Italian multicenter study on the safety and efficacy of coenzyme Q10 as adjunctive therapy in heart failure. CoQ10 Drug Surveillance Investigators. Molecular Aspects of Medicine. 1994; 15 (Suppl): s287-94.
  27. Feigin, A, Kieburtz, K, Como, P, Hickey, C, Claude, K, Abwender, D, Zimmerman, C, Steinberg, K, & Shoulson, I. Assessment of coenzyme Q10 tolerability in Huntington's disease. Movement Disorders. 1996; 11 (3): 321-3.
  28. Pepping, J. Coenzyme Q10. American Journal of Health System-Pharmacy. 1999; 56 (6): 519-21.
  29. Ernst E, Pittler MH, Wider B, Boddy K. (Eds). The Desktop Guide to Complementary and Alternative Medicine. An Evidence-Based Approach. Edinburgh: Mosby, 2006.
  30. Overvad, K, Diamant, B, Holm, L, Holmer, G, Mortensen, SA, & Stender, S. Coenzyme Q10 in health and disease. European Journal of Clinical Nutrition. 1999; 53 (10): 764-70.
  31. ConsumerLab: Product review: Coenzyme Q10.. [online]. 20011 [cited 20011 Aug 14]. Available from: URL http://www.consumerlab.com/results/coq10.asp
  32. Borek, C. Dietary antioxidants and human cancer. Integrative Cancer Therapies. 2004; 3 (4), 333-341.
  33. Engelsen J, Nielsen JD, Hansen KF. Effect of Coenzyme Q10 and Ginkgo biloba on warfarin dosage in patients on long-term warfarin treatment. A randomized, double-blind, placebo-controlled cross-over trial. Ugeskr Laeger. 2003, 28 ;165(18):1868-71.
  34. Kaikkonen, J, Nyyssonen, K, Tuomainen, TP, Ristonmaa, U, & Salonen, JT. Determinants of plasma coenzyme Q10 in humans. FEBS Letters. 1999; 443 (2): 163-6.
  35. Hoenjet KMJLF, Dagnelie PC, Delaere KPJ, Wijckmans NEG, Zambon JV, Oosterhof GON. Effect of a nutritional supplement containing vitamin E, selenium, vitamin c and coenzyme Q10 on serum PSA in patients with hormonally untreated carcinoma of the prostate: a randomised placebo-controlled study. Eur Urol. 2005 Apr;47(4):433-9; discussion 9-40.
  36. Premkumar VG, Yuvaraj S, Sathish S, Shanthi P, Sachdanandam P. Anti-angiogenic potential of CoenzymeQ10, riboflavin and niacin in breast cancer patients undergoing tamoxifen therapy. Vascul Pharmacol. 2008 Apr-Jun;48(4-6):191-201.
  37. Premkumar VG, Yuvaraj S, Shanthi P, Sachdanandam P. Co-enzyme Q10, riboflavin and niacin supplementation on alteration of DNA repair enzyme and DNA methylation in breast cancer patients undergoing tamoxifen therapy. Br J Nutr. 2008 Dec;100(6):1179-82.
  38. Premkumar VG, Yuvaraj S, Vijayasarathy K, Gangadaran SGD, Sachdanandam P. Effect of coenzyme Q10, riboflavin and niacin on serum CEA and CA 15-3 levels in breast cancer patients undergoing tamoxifen therapy. Biol Pharm Bull. 2007 Feb;30(2):367-70.
  39. Sachdanandam P. Antiangiogenic and hypolipidemic activity of coenzyme Q10 supplementation to breast cancer patients undergoing Tamoxifen therapy. Biofactors. 2008;32(1-4):151-9.
  40. Yuvaraj S, Premkumar VG, Vijayasarathy K, Gangadaran SGD, Sachdanandam P. Ameliorating effect of coenzyme Q10, riboflavin and niacin in tamoxifen-treated postmenopausal breast cancer patients with special reference to lipids and lipoproteins. Clin Biochem. 2007 Jun;40(9-10):623-8.
  41. Yuvaraj S, Premkumar VG, Vijayasarathy K, Gangadaran SGD, Sachdanandam P. Augmented antioxidant status in Tamoxifen treated postmenopausal women with breast cancer on co-administration with Coenzyme Q10, Niacin and Riboflavin. Cancer Chemother Pharmacol. 2008 May;61(6):933-41.
  42. Yuvaraj S, Premkumar VG, Shanthi P, Vijayasarathy K, Gangadaran SGD, Sachdanandam P. Effect of Coenzyme Q(10), Riboflavin and Niacin on Tamoxifen treated postmenopausal breast cancer women with special reference to blood chemistry profiles. Breast Cancer Res Treat. 2009 Mar;114(2):377-84.
  43. Perumal SS, Shanthi P, Sachdanandam P. Augmented efficacy of tamoxifen in rat breast tumorigenesis when gavaged along with riboflavin, niacin, and CoQ10: effects on lipid peroxidation and antioxidants in mitochondria. Chem Biol Interact. 2005 Feb 28;152(1):49-58.
  44. Perumal SS, Shanthi P, Sachdanandam P. Combined efficacy of tamoxifen and coenzyme Q10 on the status of lipid peroxidation and antioxidants in DMBA induced breast cancer. Mol Cell Biochem. 2005 May;273(1-2):151-60.
  45. Sakano K, Takahashi M, Kitano M, Sugimura T, Wakabayashi K. Suppression of azoxymethane-induced colonic premalignant lesion formation by coenzyme Q10 in rats. Asian Pac J Cancer Prev. 2006 Oct-Dec;7(4):599-603.
  46. Rusciani L, Proietti I, Paradisi A, Rusciani A, Guerriero G, Mammone A, et al. Recombinant interferon alpha-2b and coenzyme Q10 as a postsurgical adjuvant therapy for melanoma: a 3-year trial with recombinant interferon-alpha and 5-year follow-up. Melanoma Res. 2007 Jun;17(3):177-8
  47. Rusciani L, Proietti I, Rusciani A, Paradisi A, Sbordoni G, Alfano C, et al. Low plasma coenzyme Q10 levels as an independent prognostic factor for melanoma progression. J Am Acad Dermatol. 2006 Feb;54(2):234-41
  48. van Dalen EC, Caron HN, Dickinson HO, Kremer LC, van Dalen EC, Caron HN et al. Cardioprotective interventions for cancer patients receiving anthracyclines.[Update of Cochrane Database Syst Rev. 2008;(2):CD003917; PMID: 18425895]. Cochrane Database of Systematic Reviews 2011; 6:CD003917.
  49. Nicolson GL, Conklin KA. Reversing mitochondrial dysfunction, fatigue and the adverse effects of chemotherapy of metastatic disease by molecular replacement therapy. Clin Exp Metastasis. 2008;25(2):161-9.
  50. Coenzyme Q10 PDQ. Natural Standard Database. [online].2009 [cited 2009 May 31]. Available from URL http://www.naturalstandard.com/naturalstandard/monographinfo.asp?title=Coenzyme%20Q10&file=coenzymeq10
  51. Conklin, K. A. (2005). "Coenzyme q10 for prevention of anthracycline-induced cardiotoxicity." Integrative Cancer Therapies 4(2): 110-30.
  52. Bryant, J., J. Picot, et al. (2007)"Cardioprotection against the toxic effects of anthracyclines given to children with cancer: a systematic review." Health Technology Assessment (Winchester, England) 11(27): ii
  53. Hidaka, J, Fujii, K, et al. (2008) Safety assessment of Coenzyme Q10 (CoQ10). Biofactors 32(1-4): 499-508.
  54. Hathcock, J, Shao, (2006) A Risk Assessment for CoenzymeQ10(Ubiquinone). Regul Toxicol Pharm 45(3): 282-288.
  55. Chai W, Cooney RV, Franke AA, Shvetsov YB, Caberto CP, Wilkens LR et al. Plasma coenzyme Q10 levels and postmenopausal breast cancer risk: the multiethnic cohort study. Cancer Epidemiology, Biomarkers & Prevention 2010; 19(9):2351-2356.
  56. Cooney RV, Dai Q, Gao YT, Chow WH, Franke AA, Shu XO et al. Low plasma coenzyme q10 levels and breast cancer risk in chinese women. Cancer Epidemiology, Biomarkers & Prevention 2011; 20(6):1124-1130.
  57. Chai W, Cooney RV, Franke AA, Caberto CP, Wilkens LR, Le ML et al. Plasma coenzyme Q10 levels and prostate cancer risk: the multiethnic cohort study. Cancer Epidemiology, Biomarkers & Prevention 2011; 20(4):708-710.
  58. Chandran K, Aggarwal D, Migrino RQ, Joseph J, McAllister D, Konorev EA et al. Doxorubicin inactivates myocardial cytochrome c oxidase in rats: cardioprotection by Mito-Q. Biophysical Journal 2009; 96(4):1388-1398
  59. Fouad AA, Al-Sultan AI, Refaie SM, Yacoubi MT, Fouad AA, Al-Sultan AI et al. Coenzyme Q10 treatment ameliorates acute cisplatin nephrotoxicity in mice. Toxicology 2010; 274(1-3):49-56.
Legal notice
The present documentation has been compiled by the CAM-CANCER Project with all due care and expert knowledge. However, the CAM-CANCER Project provides no assurance, guarantee or promise with regard to the correctness, accuracy, up-to-date status or completeness of the information it contains. This information is designed for health professionals. Readers are strongly advised to discuss the information with their physician. Accordingly, the CAM-CANCER Project shall not be liable for damage or loss caused because anyone relies on the information.