Vitamin E has been recognized as an essential vitamin since their discovery in 1922. Although the functions of tocopherols are well established, tocotrienols have been the unsung heroes of vitamin E. Due to their structural differences, tocotrienols were reported to exert distinctive properties compared to tocopherols. While most vegetable oils contain higher amount of tocopherols, tocotrienols were found abundantly in palm oil. Nature has made palm vitamin E to contain up to 70% of total tocotrienols, among which alpha-, gamma- and delta-tocotrienols are the major constituents. Recent advancements have shown their biological properties in conferring protection against cancer, cardiovascular diseases, neurodegeneration, oxidative stress and immune regulation. Preclinical results of these physiological functions were translated into clinical trials gaining global attention. This review will discuss in detail the evidence in human studies to date in terms of efficacy, population, disease state and bioavailability. The review will serve as a platform to pave the future direction for tocotrienols in clinical settings.

Background Cancer is the second leading cause of death globally. The increasing cost of treatment and adverse effects often seen with conventional therapies have shifted the attention towards a multidisciplinary approach which includes the use of nutraceuticals as an alternative. Curcumin, resveratrol and tocotrienols are among the natural compounds with anti-cancer properties that have been studied in line with the concept “from bench to bedside”. Among these nutraceuticals, tocotrienols being a member of vitamin E family has been studied in depth in the last 3 decades. However, alpha-tocopherol which is a lesser potent isoform, is often mistaken as a general term for Vitamin E, thus making tocotrienols as the unsung heroes in anti-cancer research despite their beneficial biological properties. This poster is aimed to provide the overview of the anti-cancer effects of tocotrienols based on evidence from in vitro, in vivo and clinical trials. Methods Following numerous pre-clinical studies, two clinical trials involving cancer patients were conducted. The first pilot study was conducted in 240 women with early breast cancer in Kuala Lumpur General Hospital and the second study was carried out in 25 presurgical patients with pancreatic ductal neoplasia in H. Lee Moffitt Cancer Center and Research Institute, USA. Results Based on the pre-clinical studies, the anti-cancer activity of tocotrienols have been attributed to their anti-proliferative, anti-angiogenic, pro-apoptotic and immune enhancing effects. In addition, new self-emulsified formulations have improved the bioavailability of tocotrienols in humans that has been a debated issue in the past. Conclusion Despite emerging new studies showing evidence that circulating plasma tocotrienol levels are sufficient to evoke therapeutic response, more clinical studies are warranted to convince the scientific community, clinicians and healthcare authorities on the potential role of tocotrienols as an anti-cancer agent.