Xylitol and Cancer

Xylitol is a sugar alcohol used most commonly in oral hygiene products because of its anticaries and anti-inflammatory properties. Few studies, however, have evaluated the role of xylitol as a carcinogen or for the treatment of cancer or cancer-related complications.

Benefits for Xerostomia

Supportive treatment for radiation-induced xerostomia includes oral hygiene and saliva substitutes. Xylitol is included in several preparations that have been evaluated for the treatment of xerostomia.

A single-arm study of 34 patients with radiation-induced xerostomia found that BioXtra, an oral saliva substitute that consists of xylitol, enzymes, colostrum whey extract, moisturizers, fluoride, and lactoferrin significantly improved quality of life scores (P < .001) with a response rate of 77%. There were no adverse events reported.¹

Another single-arm study that evaluated 40 patients with radiation-induced xerostomia demonstrated improvement in all quality of life scores (significance achieved in 7 out of 15 domains) and a 45% increase in salivary flow with Xerostom oral products (toothpaste, mouthrinse, spray, and gel) compared with baseline values.

Xerostom products contain xylitol, olive oil, and betaine. The only adverse event was itching among 7% of patients, which rapidly resolved.²

In Vitro Evidence of Anticancer Activity

An in vitro study of lung cancer cell lines demonstrated that xylitol has a dose-dependent inhibitory effect on cell proliferation, which may be achieved through autophagy.³

Another study demonstrated that xylitol has an antiproliferative effect in vitro. In this study, nontransformed cells and oral squamous cell cancer cell lines were treated with glucose or partial substation of glucose with xylitol or sorbitol. Partial substitution of glucose with xylitol resulted in decreased cell proliferation. The mechanism was likely related to downregulation of glycolysis because partial replacement of glucose with xylitol decreased adenosine triphosphate (ATP) generation and phosphofructokinase activity. A metabolite of xylitol, D-xylulose, enhanced the antiproliferative activity of xylitol.⁴

Conclusions

There are no data to suggest that xylitol is carcinogenic or is associated with an increased risk of cancer. Two in vitro studies suggest that xylitol may have antiproliferative properties, but this has not been investigated among human subjects.

Xylitol may be an effective agent for providing relief from radiation-induced xerostomia, though the reviewed studies did not evaluate xylitol as a single-agent, but rather in a product with multiple potentially beneficial constituents.

References

1. Dirix P, Nuyts S, Vander Poorten V, Delaere P, Van den Bogaert W. Efficacy of the BioXtra dry mouth care system in the treatment of radiotherapy-induced xerostomia. Support Care Cancer. 2007;15:1429-36.
2. Martín M, Marín A, Lopez M, et al. Products based on olive oil, betaine, and xylitol in the post-radiotherapy xerostomia. Rep Pract Oncol Radiother. 2017;22:71-6. doi: 10.1016/j.rpor.2016.09.008
3. Park E, Park MH, Na HS, Chung J. Xylitol induces cell death in lung cancer A549 cells by autophagy. Biotechnol Lett. 2015;37:983-90. doi: 10.1007/s10529-014-1757-1
4. Trachootham D, Chingsuwanrote P, Yoosadiang P, et al. Partial substitution of glucose with xylitol suppressed the glycolysis and selectively inhibited the proliferation of oral cancer cells. Nutr Cancer. 2017;69:862-72. doi: 10.1080/01635581.2017.1339097