Synopsis

Source of validity: Scientific
Rating (out of 5): 2

Bicarbonate (usually sodium bicarbonate) is sometimes used in oncology settings to help manage certain side effects of chemotherapy, particularly those related to tumor lysis syndrome (TLS) and chemotherapy-induced metabolic acidosis. The rationale is that chemotherapy can cause rapid breakdown of tumor cells, releasing large amounts of uric acid and other metabolites, which can acidify the blood and urine. Bicarbonate may be administered to alkalinize urine, thereby decreasing the risk of uric acid nephropathy and facilitating the excretion of certain toxic metabolites.

However, the scientific support for this practice is moderate and somewhat controversial. Some clinical guidelines and studies suggest that routine urinary alkalinization with bicarbonate does not confer significant benefit over aggressive hydration alone and may even increase the risk of calcium phosphate precipitation. As a result, its use is becoming less common and more targeted to specific clinical scenarios.

There is little evidence to suggest that bicarbonate directly reduces other chemotherapy side effects (e.g., nausea, mucositis). Its use is not based on tradition but rather on pathophysiological reasoning and some clinical experience, mostly for TLS. Overall, the evidence supporting its routine use to prevent or treat chemotherapy side effects is limited, and its application should be individualized based on patient risk factors and clinical context.

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