Given the safety and potential benefits of intravenous ascorbic acid (AA) administration in cancer patients, there is merit in further exploring this therapeutic concept. In this review, we discuss the potential benefits of intravenous AA administration on colorectal cancer and we specifically focus on its effect on glycolysis in mutant and wild type RAS. We perform a PubMed and Ovid MEDLINE search using ascorbic acid, intravenous vitamin C, KRAS mutation, BRAF mutation and colorectal cancer (CRC) as keywords. At the cellular level, colorectal cancer cells undergo a metabolic shift called the Warburg effect to allow for more glucose absorption and utilization of glycolysis. This shift also allows AA to enter which leads to a disruption in the Warburg effect and a shutdown of the downstream KRAS pathway in mutated KRAS colon cancer cells. At the clinical level, AA is associated with tumour regression in advanced disease and improved tolerability and side effects of standard therapy. Based on these findings, we conclude that further clinical trials are needed on a larger scale to examine the therapeutic benefits of AA in colon cancer.

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Background/Aims: Pancreatic neuroendocrine tumors (p-NETs) are a group of functionally and biologically heterogeneous tumors which are clinically rare. Here we report the clinical features, treatment strategies and survival of p-NET patients treated at a single institution. Methods: Patients pathologically diagnosed with p-NETs and treated at The American University of Beirut Medical Center between 2005 and 2015 were recruited. Tissue specimens from patients' samples were collected during surgical resections and needle biopsies performed at our center to determine tumor characteristics. The 2010 WHO NET and ENETs classification systems were used in concordance for all cases to determine staging. The WHO divided the p-NET grades into: Grade 1 neuroendocrine tumors (G1), Grade 2 neuroendocrine tumors (G2), Grade 3 neuroendocrine carcinoma (G3) and mixed adeno and neuroendocrine carcinoma (MANEC). Survival analyses using Kaplan-Meier were plotted using SPSS 23.0 (IBM). Results: We identified 27 p-NET patients with pathological reports. Median age of patients at diagnosis was 52 years. The majority were males (63%). The proportions of patients with pathologic TNM stages IA/B, IIA/B, III, and IV disease were 18%, 22%, 4%, and 56% of all patients. Seventeen patients (63%) underwent surgery and eighteen patients (67%) received chemotherapy and/or somatostatin analogues. Median survival of the whole cohort was more than 10.8 years while the median survival of patients diagnosed at stage IV was 6 years. The one and two-year survival rates for the entire cohort were 97% and 83%, respectively. The one and two-year survival rates of stage IV were 93% and 70%, respectively. Conclusion: Because of their variable presentations and non-standardized treatment plans, p-NETs still represent a significant clinical challenge and their management requires a coordinated multidisciplinary approach.