Balanced Duality: H 2 O 2 -Based Therapy in Cancer and Its Protective Effects on Non-Malignant Tissues.

Conventional cancer therapy strategies, although centered around killing tumor cells, often lead to severe side effects on surrounding normal tissues, thus compromising the chronic quality of life in cancer survivors. Hydrogen peroxide (H ₂ O ₂ ) is a secondary signaling molecule that has an array of functions in both tumor and normal cells, including the promotion of cell survival pathways and immune cell modulation in the tumor microenvironment. H ₂ O ₂ is a reactive oxygen species (ROS) crucial in cellular homeostasis and signaling (at concentrations maintained under nM levels), with increased steady-state levels in tumors relative to their normal tissue counterparts. Increased steady-state levels of H ₂ O ₂ in tumor cells, make them vulnerable to oxidative stress and ultimately, cell death. Recently, H ₂ O ₂ -producing therapies-namely, pharmacological ascorbate and superoxide dismutase mimetics-have emerged as compelling complementary treatment strategies in cancer. Both pharmacological ascorbate and superoxide dismutase mimetics can generate excess H ₂ O ₂ to overwhelm the impaired H ₂ O ₂ removal capacity of cancer cells. This review presents an overview of H ₂ O ₂ metabolism in the physiological and malignant states, in addition to discussing the anti-tumor and normal tissue-sparing mechanism(s) of, and clinical evidence for, two H ₂ O ₂ -based therapies, pharmacological ascorbate and superoxide dismutase mimetics.