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De Sanctis V, Bossi P, Sanguineti G, Trippa F, Ferrari D, Bacigalupo A, Ripamonti CI, Buglione M, Pergolizzi S, Langendjik JA, Murphy B, Raber-Durlacher J, Russi EG, Lalla RV. Mucositis in head and neck cancer patients treated with radiotherapy and systemic therapies: Literature review and consensus statements. Crit Rev Oncol Hematol 2016; 100:147-66. [DOI: 10.1016/j.critrevonc.2016.01.010] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 11/30/2015] [Accepted: 01/14/2016] [Indexed: 12/27/2022] Open
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Kim KS, Jeon SU, Lee CJ, Kim YE, Bok S, Hong BJ, Park DY, Ahn GO, Kim HJ. Radiation-Induced Esophagitis In Vivo and In Vitro Reveals That Epidermal Growth Factor Is a Potential Candidate for Therapeutic Intervention Strategy. Int J Radiat Oncol Biol Phys 2016; 95:1032-1041. [PMID: 27130791 DOI: 10.1016/j.ijrobp.2016.02.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Revised: 01/18/2016] [Accepted: 02/17/2016] [Indexed: 12/28/2022]
Abstract
PURPOSE To establish and characterize radiation-induced esophagitis (RIE) in vivo and in vitro. METHODS AND MATERIALS Fractionated thoracic irradiation at 0, 8, 12, or 15 Gy was given daily for 5 days to Balb/c or C57Bl/6 mice. Changes in body weight gain and daily food intake were assessed. At the end of the study, we removed the esophagus and examined histology by hematoxylin and eosin staining, immune cell infiltration and apoptosis by fluorescence-activated cell sorting, and gene expression changes by quantitative real-time polymerase chain reaction. Het-1A human esophageal epithelial cells were irradiated at 6 Gy, treated with recombinant human growth factors, and examined for gene expression changes, apoptosis, proliferation, and signal transduction pathways. RESULTS We observed that irradiation at 12 Gy or 15 Gy per fraction produced significant reduction in body weight and decreased food intake in Balb/c mice but not as much in C57Bl/6 mice. Further analyses of Balb/c mice irradiated at 12 Gy/fraction revealed attenuated epithelium, inflamed mucosa, and increased numbers of infiltrating CD4+ helper T cells and apoptotic cells. Moreover, we found that expression of tissue inhibitor for metalloproteinase-1, plasminogen activator inhibitor-1, granulocyte macrophage-colony stimulating factor, vascular endothelial growth factor, and stromal-derived factor-1 were increased, whereas epidermal growth factor (EGF) was decreased. Irradiated Het-1A cells similarly showed a significant decrease in expression of EGF and connective tissue growth factor (CTGF). Treatment of EGF but not CTGF partially protected Het-1A cells from radiation-induced apoptosis and revealed phosphorylation of EGFR, AKT, and ERK signaling pathways. CONCLUSIONS We established a mouse model of RIE in Balb/c mice with 12 Gy × 5 fractions, which showed reduced body weight gain, food intake, and histopathologic features similar to those of human esophagitis. Decreased EGF expression in the irradiated esophagus suggests that EGF may be a potential therapeutic intervention strategy to treat RIE.
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Affiliation(s)
- Kyung Su Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea
| | - Seong-Uk Jeon
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang, Gyeongbuk, Korea
| | - Chan-Ju Lee
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang, Gyeongbuk, Korea
| | - Young-Eun Kim
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang, Gyeongbuk, Korea
| | - Seoyeon Bok
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang, Gyeongbuk, Korea
| | - Beom-Ju Hong
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang, Gyeongbuk, Korea
| | - Dong-Young Park
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang, Gyeongbuk, Korea
| | - G-One Ahn
- Division of Integrative Biosciences and Biotechnology, Pohang University of Science and Technology, Pohang, Gyeongbuk, Korea.
| | - Hak Jae Kim
- Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea.
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Ardito F, Giuliani M, Perrone D, Giannatempo G, Di Fede O, Favia G, Campisi G, Colella G, Lo Muzio L. Expression of salivary biomarkers in patients with oral mucositis: evaluation by SELDI-TOF/MS. Oral Dis 2016; 22:209-19. [PMID: 26613366 DOI: 10.1111/odi.12405] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/15/2015] [Accepted: 11/18/2015] [Indexed: 01/15/2023]
Affiliation(s)
- F Ardito
- Department of Clinical and Experimental Medicine; Foggia University; Foggia Italy
| | - M Giuliani
- Department of Clinical and Experimental Medicine; Foggia University; Foggia Italy
| | - D Perrone
- Department of Clinical and Experimental Medicine; Foggia University; Foggia Italy
| | - G Giannatempo
- Department of Clinical and Experimental Medicine; Foggia University; Foggia Italy
| | - O Di Fede
- Department of Surgical, Oncological and Stomatological Sciences; University of Palermo; Palermo Italy
| | - G Favia
- Department of Odontostomatology and Surgery; University of Bari; Bari Italy
| | - G Campisi
- Department of Surgical, Oncological and Stomatological Sciences; University of Palermo; Palermo Italy
| | - G Colella
- Department of Medical, Surgical and Dental Specialties; Second University of Naples; Naples Italy
| | - L Lo Muzio
- Department of Clinical and Experimental Medicine; Foggia University; Foggia Italy
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Long-Term Safety Outcomes in Patients with Hematological Malignancies Undergoing Autologous Hematopoietic Stem Cell Transplantation Treated with Palifermin to Prevent Oral Mucositis. Biol Blood Marrow Transplant 2016; 22:164-9. [DOI: 10.1016/j.bbmt.2015.08.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Accepted: 08/13/2015] [Indexed: 11/24/2022]
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Riley P, Glenny AM, Worthington HV, Littlewood A, Clarkson JE, McCabe MG. Interventions for preventing oral mucositis in patients with cancer receiving treatment: cytokines and growth factors. Hippokratia 2015. [DOI: 10.1002/14651858.cd011990] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Philip Riley
- School of Dentistry, The University of Manchester; Cochrane Oral Health Group; JR Moore Building Oxford Road Manchester UK M13 9PL
| | - Anne-Marie Glenny
- School of Dentistry, The University of Manchester; Cochrane Oral Health Group; JR Moore Building Oxford Road Manchester UK M13 9PL
| | - Helen V Worthington
- School of Dentistry, The University of Manchester; Cochrane Oral Health Group; JR Moore Building Oxford Road Manchester UK M13 9PL
| | - Anne Littlewood
- School of Dentistry, The University of Manchester; Cochrane Oral Health Group; JR Moore Building Oxford Road Manchester UK M13 9PL
| | - Jan E Clarkson
- University of Dundee; Division of Oral Health Sciences; Dental Hospital & School Park Place Dundee Scotland UK DD1 4HR
| | - Martin G McCabe
- The University of Manchester; Centre for Paediatric, Teenage and Young Adult Cancer; Manchester Academic Health Science Centre Manchester UK
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Van Sebille YZA, Stansborough R, Wardill HR, Bateman E, Gibson RJ, Keefe DM. Management of Mucositis During Chemotherapy: From Pathophysiology to Pragmatic Therapeutics. Curr Oncol Rep 2015; 17:50. [DOI: 10.1007/s11912-015-0474-9] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Ogata Y, Ishibashi N, Yamaguchi K, Uchida S, Kamei H, Nakayama G, Hirakawa H, Tanigawa M, Akagi Y. Preventive effects of amino-acid-rich elemental diet Elental® on chemotherapy-induced oral mucositis in patients with colorectal cancer: a prospective pilot study. Support Care Cancer 2015; 24:783-789. [PMID: 26266658 PMCID: PMC4689768 DOI: 10.1007/s00520-015-2844-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2014] [Accepted: 07/06/2015] [Indexed: 02/06/2023]
Abstract
Purpose The prospective pilot study was designed to evaluate the preventive effects of amino-acid-rich elemental diet (ED), Elental®, on chemotherapy-induced oral mucositis in patients with colorectal cancer. The factors influencing its efficacy are also investigated. Methods A total of 22 eligible patients with colorectal cancer experiencing grade 1–3 oral mucositis during treatment with fluorouracil-based chemotherapy entered the current study. Their average age was 67 years. There were 10 male and 12 female. The PS was 0 in the majority of patients. Patients received two courses of the same chemotherapy regimen and Elental® concurrently after recovery to grade 0 or 1 oral mucositis. Results FOLFOX6 + bevacizumab in 8 patients, FOLFIRI + bevacizumab in 8 patients, FOLFIRI + panitumumab in 1 patient, FOLFIRI in 1 patient, XELOX + bevacizumab in 2 patients, and S-1 + cetuximab in 2 patients were used as first-line (16 cases) or as second-line (6 cases) chemotherapy. Dose reduction of 5-fluorouracil (5-FU) or oral fluoropyrimidine was performed in the 2 patients achieving grade 3 oral mucositis and in the 3 patients achieving grade 2 oral mucositis. The maximum grade of oral mucositis decreased in 18 of the 22 patients during the first treatment course with Elental® (p = 0.0002) and in 20 of the 22 patients in the second course (p < 0.0001). Multivariate analyses found that the dose reduction in 5-FU or oral fluoropyrimidine, ED intake, and the prior administration of ED were each a significant factor for the preventive efficacy on oral mucositis. Conclusion The amino-acid-rich elemental diet Elental® may be useful as a countermeasure for 5-FU-based chemotherapy-induced oral mucositis in patients with colorectal cancer.
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Affiliation(s)
- Yutaka Ogata
- Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan.
| | - Nobuya Ishibashi
- Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan
| | - Keizou Yamaguchi
- Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan
| | - Shinji Uchida
- Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan
| | - Hideki Kamei
- Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan
| | - Goichi Nakayama
- Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan
| | - Hiroaki Hirakawa
- Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan
| | - Masahiko Tanigawa
- Department of Surgery, Kurume University Medical Center, 155-1 Kokubu-machi, Kurume, 839-0863, Japan
| | - Yoshito Akagi
- Department of Surgery, Kurume University School of Medicine, Kurume, 830-0011, Japan
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Chang CT, Hsiang CY, Ho TY, Wu CZ, Hong HH, Huang YF. Comprehensive Assessment of Host Responses to 5-Fluorouracil-Induced Oral Mucositis through Transcriptomic Analysis. PLoS One 2015; 10:e0135102. [PMID: 26266941 PMCID: PMC4534454 DOI: 10.1371/journal.pone.0135102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 07/16/2015] [Indexed: 11/18/2022] Open
Abstract
Background Chemotherapy plays an important role in current cancer therapy; however, several problems remain unsolved on the issue of host-therapeutics interaction. The purpose of this study was to investigate the host responses after 5-flurouracil (5-FU) administration and to find the target genes and their relationship with other cytokines in the 5-FU-induced oral mucositis (OM) mouse model through transcriptomic analysis. Materials and Methods Thirty-six 6 to 8 week-old male BALB/c mice were randomly divided into the control group and 5-FU-treated group. In the 5-FU group, mice received 5-FU (100 mg/kg, intraperitoneally) on day 1, day 8, day 15, day 22, and day 29, respectively. We evaluated the oral mucosal change under macroanalysis and histological examination at indicated periods, and then applied transcriptomic analysis of gene expression profile and Immunohistochemical stain to identify the target molecules related to 5-FU-induced OM. Results The most prominent histological change in this model was observed in the fifth week. The gene expression of Bone gamma-carboxyglutamate protein, related sequence 1 (Bglap-rs1) (–12.69-fold) and Chitinase 3-like 4 (Chi3l4) (–6.35-fold) were significantly down-regulated in this phase. The quantitative real-time PCR results also revealed the expression levels were 0.62-fold in Bglap-rs1 and 0.13-fold in Chi3l4 compared with the control group. Immunohistochemical stain showed significant expression of cluster of differentiation 11b (p<0.01), interleukin-1β (p<0.001) and tumor necrosis factor-α (p<0.05), and down-regulation of Bglap-rs1 (p<0.01) compared with the control group. By Kyoto Encyclopedia of Genes and Genomes pathway analysis, there were twenty-three pathways significantly participated in this study (p<0.05). Conclusions Through comprehensively transcriptomic analysis and IHC stain, we discovered several valuable pathways, verified the main pro-inflammatory cytokines, and revealed two significantly down-regulated genes in the 5-FU-induced OM model. These findings highlighted the way of seeking effective therapeutic agents for chemotherapy-induced OM in future.
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Affiliation(s)
- Chung-Ta Chang
- Department of Emergency Medicine, Far Eastern Memorial Hospital, Taipei, 22056, Taiwan
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, 11031, Taiwan
| | - Chien-Yun Hsiang
- Department of Microbiology, China Medical University, Taichung, 40402, Taiwan
| | - Tin-Yun Ho
- Graduate Institute of Chinese Medicine, China Medical University, Taichung, 40402, Taiwan
| | - Ching-Zong Wu
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, 11031, Taiwan
- Department of Dentistry, Taipei Medical University Hospital, Taipei, 11031, Taiwan
- Department of Dentistry, Lotung Poh-Ai Hospital, Yilan, 26546, Taiwan
| | - Hsiang-Hsi Hong
- Department of Periodontics, Chang Gung Memorial Hospital, Linkou, 33305, Taiwan
- Graduate Institute of Dental and Craniofacial Science, Chang-Gung University, Taoyuan, 33302, Taiwan
| | - Yi-Fang Huang
- School of Dentistry, College of Oral Medicine, Taipei Medical University, Taipei, 11031, Taiwan
- Department of General Dentistry, Chang Gung Memorial Hospital, Linkou, 33305, Taiwan
- * E-mail:
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Fonseca AS, Campos VMA, Magalhães LAG, Paoli F. Nucleotide excision repair pathway assessment in DNA exposed to low-intensity red and infrared lasers. ACTA ACUST UNITED AC 2015; 48:929-38. [PMID: 26445337 PMCID: PMC4617120 DOI: 10.1590/1414-431x20154457] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 03/17/2015] [Indexed: 02/02/2023]
Abstract
Low-intensity lasers are used for prevention and management of oral mucositis induced
by anticancer therapy, but the effectiveness of treatment depends on the genetic
characteristics of affected cells. This study evaluated the survival and induction of
filamentation of Escherichia coli cells deficient in the nucleotide
excision repair pathway, and the action of T4endonuclease V on plasmid DNA
exposed to low-intensity red and near-infrared laser light. Cultures of wild-type
(strain AB1157) E. coli and strain AB1886 (deficient in uvrA
protein) were exposed to red (660 nm) and infrared (808 nm) lasers at various
fluences, powers and emission modes to study bacterial survival and filamentation.
Also, plasmid DNA was exposed to laser light to study DNA lesions produced in
vitro by T4endonuclease V. Low-intensity
lasers:i) had no effect on survival of wild-type E.
coli but decreased the survival of uvrA protein-deficient
cells,ii) induced bacterial filamentation, iii)
did not alter the electrophoretic profile of plasmids in agarose gels,
andiv) did not alter the electrophoretic profile of plasmids
incubated with T4 endonuclease V. These results increase our understanding
of the effects of laser light on cells with various genetic characteristics, such as
xeroderma pigmentosum cells deficient in nucleotide excision pathway activity in
patients with mucositis treated by low-intensity lasers.
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Affiliation(s)
- A S Fonseca
- Laboratório de Ciências Radiológicas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Rio de Janeiro, RJ, BR
| | - V M A Campos
- Laboratório de Ciências Radiológicas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Rio de Janeiro, RJ, BR
| | - L A G Magalhães
- Laboratório de Ciências Radiológicas, Departamento de Biofísica e Biometria, Instituto de Biologia Roberto Alcântara Gomes, Rio de Janeiro, RJ, BR
| | - F Paoli
- Departamento de Morfologia, Instituto de Ciências Biológicas, Universidade Federal de Juiz de Fora, Juiz de Fora, MG, BR
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Cirillo N, Vicidomini A, McCullough M, Gambardella A, Hassona Y, Prime SS, Colella G. A hyaluronic acid-based compound inhibits fibroblast senescence induced by oxidative stress in vitro and prevents oral mucositis in vivo. J Cell Physiol 2015; 230:1421-9. [DOI: 10.1002/jcp.24908] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2014] [Accepted: 12/18/2014] [Indexed: 11/09/2022]
Affiliation(s)
- Nicola Cirillo
- Melbourne Dental School and Oral Health CRC; The University of Melbourne; Melbourne VIC Australia
| | - Antonio Vicidomini
- Dipartimento Multidisciplinare di Specialit; à; Medico-chirurgiche ed Odontoiatriche; Seconda Università degli Studi di Napoli; Napoli Italy
| | - Michael McCullough
- Melbourne Dental School and Oral Health CRC; The University of Melbourne; Melbourne VIC Australia
| | - Antonio Gambardella
- Dipartimento Multidisciplinare di Specialit; à; Medico-chirurgiche ed Odontoiatriche; Seconda Università degli Studi di Napoli; Napoli Italy
| | - Yazan Hassona
- Department of Dentistry; University of Jordan; Amman Jordan
| | - Stephen S. Prime
- Centre for Clinical and Diagnostic Oral Sciences; Institute of Dentistry; Barts and the London School of Medicine and Dentistry; Queen Mary University of London; London UK
| | - Giuseppe Colella
- Dipartimento Multidisciplinare di Specialit; à; Medico-chirurgiche ed Odontoiatriche; Seconda Università degli Studi di Napoli; Napoli Italy
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Sung L, Robinson P, Treister N, Baggott T, Gibson P, Tissing W, Wiernikowski J, Brinklow J, Dupuis LL. Guideline for the prevention of oral and oropharyngeal mucositis in children receiving treatment for cancer or undergoing haematopoietic stem cell transplantation. BMJ Support Palliat Care 2015; 7:7-16. [PMID: 25818385 PMCID: PMC5339548 DOI: 10.1136/bmjspcare-2014-000804] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 02/25/2015] [Accepted: 03/11/2015] [Indexed: 11/03/2022]
Abstract
PURPOSE To develop an evidence-based clinical practice guideline for the prevention of oral mucositis in children (0-18 years) receiving treatment for cancer or undergoing haematopoietic stem cell transplantation (HSCT). METHODS The Mucositis Prevention Guideline Development Group was interdisciplinary and included internationally recognised experts in paediatric mucositis. For the evidence review, we included randomised controlled trials (RCTs) conducted in either children or adults evaluating the following interventions selected according to prespecified criteria: cryotherapy, low level light therapy (LLLT) and keratinocyte growth factor (KGF). We also examined RCTs of any intervention conducted in children. For all systematic reviews, we synthesised the occurrence of severe oral mucositis. The Grades of Recommendation, Assessment, Development and Evaluation approach was used to describe quality of evidence and strength of recommendations. RESULTS We suggest cryotherapy or LLLT may be offered to cooperative children receiving chemotherapy or HSCT conditioning with regimens associated with a high rate of mucositis. We also suggest KGF may be offered to children receiving HSCT conditioning with regimens associated with a high rate of severe mucositis. However, KGF use merits caution as there is a lack of efficacy and toxicity data in children, and a lack of long-term follow-up data in paediatric cancers. No other interventions were recommended for oral mucositis prevention in children. CONCLUSIONS All three specific interventions evaluated in this clinical practice guideline were associated with a weak recommendation for use. There may be important organisational and cost barriers to the adoption of LLLT and KGF. Considerations for implementation and key research gaps are highlighted.
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Affiliation(s)
- Lillian Sung
- Division of Haematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Paula Robinson
- Pediatric Oncology Group of Ontario, Toronto, Ontario, Canada
| | - Nathaniel Treister
- Division of Oral Medicine and Dentistry, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Tina Baggott
- Cancer Clinical Trials Office, Stanford University, Stanford, California, USA
| | - Paul Gibson
- Section of Hematology and Oncology, Children's Hospital, Western University, London, Ontario, Canada
| | - Wim Tissing
- Department of Pediatric Oncology/Hematology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - John Wiernikowski
- Division of Pediatric Hematology/Oncology, McMaster University, McMaster Children's Hospital, Hamilton, Ontario, Canada
| | - Jennifer Brinklow
- Division of Pediatric Hematology/Oncology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - L Lee Dupuis
- Division of Haematology/Oncology, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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Nguyen DT, Shayani S, Palmer J, Dagis A, Forman SJ, Epstein J, Spielberger R. Palifermin for prevention of oral mucositis in allogeneic hematopoietic stem cell transplantation: a single-institution retrospective evaluation. Support Care Cancer 2015; 23:3141-7. [DOI: 10.1007/s00520-015-2688-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 02/23/2015] [Indexed: 10/23/2022]
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Ramadan A, Paczesny S. Various forms of tissue damage and danger signals following hematopoietic stem-cell transplantation. Front Immunol 2015; 6:14. [PMID: 25674088 PMCID: PMC4309199 DOI: 10.3389/fimmu.2015.00014] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Accepted: 01/08/2015] [Indexed: 12/13/2022] Open
Abstract
Hematopoietic stem-cell transplantation (HSCT) is the most potent curative therapy for many malignant and non-malignant disorders. Unfortunately, a major complication of HSCT is graft-versus-host disease (GVHD), which is mediated by tissue damage resulting from the conditioning regimens before the transplantation and the alloreaction of dual immune components (activated donor T-cells and recipient’s antigen-presenting cells). This tissue damage leads to the release of alarmins and the triggering of pathogen-recognition receptors that activate the innate immune system and subsequently the adaptive immune system. Alarmins, which are of endogenous origin, together with the exogenous pathogen-associated molecular patterns (PAMPs) elicit similar responses of danger signals and represent the group of damage-associated molecular patterns (DAMPs). Effector cells of innate and adaptive immunity that are activated by PAMPs or alarmins can secrete other alarmins and amplify the immune responses. These complex interactions and loops between alarmins and PAMPs are particularly potent at inducing and then aggravating the GVHD reaction. In this review, we highlight the role of these tissue damaging molecules and their signaling pathways. Interestingly, some DAMPs and PAMPs are organ specific and GVHD-induced and have been shown to be interesting biomarkers. Some of these molecules may represent potential targets for novel therapeutic approaches.
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Affiliation(s)
- Abdulraouf Ramadan
- Department of Pediatrics, Melvin and Bren Simon Cancer Center, Indiana University , Indianapolis, IN , USA ; Department of Microbiology and Immunology, Indiana University , Indianapolis, IN , USA
| | - Sophie Paczesny
- Department of Pediatrics, Melvin and Bren Simon Cancer Center, Indiana University , Indianapolis, IN , USA ; Department of Microbiology and Immunology, Indiana University , Indianapolis, IN , USA
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Bian L, Han G, Zhao CW, Garl PJ, Wang XJ. The role of Smad7 in oral mucositis. Protein Cell 2015; 6:160-9. [PMID: 25566830 PMCID: PMC4348243 DOI: 10.1007/s13238-014-0130-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 12/12/2014] [Indexed: 12/23/2022] Open
Abstract
Oral mucositis, a severe oral ulceration, is a common toxic effect of radio- or chemoradio-therapy and a limiting factor to using the maximum dose of radiation for effective cancer treatment. Among cancer patients, at least 40% and up to 70%, of individuals treated with standard chemotherapy regimens or upper-body radiation, develop oral mucositis. To date, there is no FDA approved drug to treat oral mucositis in cancer patients. The key challenges for oral mucositis treatment are to repair and protect ulcerated oral mucosa without promoting cancer cell growth. Oral mucositis is the result of complex, multifaceted pathobiology, involving a series of signaling pathways and a chain of interactions between the epithelium and submucosa. Among those pathways and interactions, the activation of nuclear factor-kappa B (NF-κB) is critical to the inflammation process of oral mucositis. We recently found that activation of TGFβ (transforming growth factor β) signaling is associated with the development of oral mucositis. Smad7, the negative regulator of TGFβ signaling, inhibits both NF-κB and TGFβ activation and thus plays a pivotal role in the prevention and treatment of oral mucositis by attenuating growth inhibition, apoptosis, and inflammation while promoting epithelial migration. The major objective of this review is to evaluate the known functions of Smad7, with a particular focus on its molecular mechanisms and its function in blocking multiple pathological processes in oral mucositis.
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Affiliation(s)
- Li Bian
- Department of Pathology, The First Affiliated Hospital of Kunming Medical University, Kunming, 650032, China
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Elad S, Raber-Durlacher JE, Brennan MT, Saunders DP, Mank AP, Zadik Y, Quinn B, Epstein JB, Blijlevens NMA, Waltimo T, Passweg JR, Correa MEP, Dahllöf G, Garming-Legert KUE, Logan RM, Potting CMJ, Shapira MY, Soga Y, Stringer J, Stokman MA, Vokurka S, Wallhult E, Yarom N, Jensen SB. Basic oral care for hematology-oncology patients and hematopoietic stem cell transplantation recipients: a position paper from the joint task force of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT). Support Care Cancer 2015; 23:223-36. [PMID: 25189149 PMCID: PMC4328129 DOI: 10.1007/s00520-014-2378-x] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2014] [Accepted: 07/30/2014] [Indexed: 12/17/2022]
Abstract
PURPOSE Hematology-oncology patients undergoing chemotherapy and hematopoietic stem cell transplantation (HSCT) recipients are at risk for oral complications which may cause significant morbidity and a potential risk of mortality. This emphasizes the importance of basic oral care prior to, during and following chemotherapy/HSCT. While scientific evidence is available to support some of the clinical practices used to manage the oral complications, expert opinion is needed to shape the current optimal protocols. METHODS This position paper was developed by members of the Oral Care Study Group, Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and the European Society for Blood and Marrow Transplantation (EBMT) in attempt to provide guidance to the health care providers managing these patient populations. RESULTS The protocol on basic oral care outlined in this position paper is presented based on the following principles: prevention of infections, pain control, maintaining oral function, the interplay with managing oral complications of cancer treatment and improving quality of life. CONCLUSION Using these fundamental elements, we developed a protocol to assist the health care provider and present a practical approach for basic oral care. Research is warranted to provide robust scientific evidence and to enhance this clinical protocol.
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Affiliation(s)
- Sharon Elad
- Division of Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, 625 Elmwood Ave., Rochester, NY, 14620, USA,
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8-prenylnaringenin and tamoxifen inhibit the shedding of irradiated epithelial cells and increase the latency period of radiation-induced oral mucositis. Strahlenther Onkol 2014; 191:429-36. [DOI: 10.1007/s00066-014-0782-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 10/30/2014] [Indexed: 10/24/2022]
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67
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Eilers J, Harris D, Henry K, Johnson LA. Evidence-Based Interventions for Cancer Treatment-Related Mucositis: Putting Evidence Into Practice. Clin J Oncol Nurs 2014; 18 Suppl:80-96. [DOI: 10.1188/14.cjon.s3.80-96] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Seiler S, Kosse J, Loibl S, Jackisch C. Adverse event management of oral mucositis in patients with breast cancer. ACTA ACUST UNITED AC 2014; 9:232-7. [PMID: 25404881 DOI: 10.1159/000366246] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Oral mucositis (OM) is a clinically important and frequent adverse event (AE) associated with cancer treatment with conventional chemotherapy as well as new targeted agents. Incidence and severity of OM vary from treatment to treatment and from patient to patient. The pathogenesis of chemotherapy-induced OM can be divided into 5 phases. OM induced by targeted therapies differs among other things in appearance, course, concomitant AEs and toxicity, and thus could be perceived as an entity distinct from chemotherapy-induced OM with an innate pathogenic mechanism. OM has a severe impact on a patient's quality of life (QoL) by causing complications such as pain and discomfort. Even more important are associated restrictions in nutrition and hydration. Thus, the efficacy of cancer therapy might be impaired due to the necessity of dose delays and dose reductions. Numerous preventive and therapeutic approaches have been evaluated, but currently no single agent has changed the standard of care in preventing and treating OM. Thus, the current management has evolved from clinical experience rather than clinical evidence. This article will review the AE 'OM' induced by breast cancer treatment with chemotherapy and targeted agents in order to provide practical guidance for management and prevention.
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Affiliation(s)
- Sabine Seiler
- Department of Obstetrics and Gynaecology, Breast Cancer Center, Offenbach, Germany
| | - Jens Kosse
- Department of Obstetrics and Gynaecology, Breast Cancer Center, Offenbach, Germany
| | - Sibylle Loibl
- Department of Obstetrics and Gynaecology, Breast Cancer Center, Offenbach, Germany ; German Breast Group, Neu-Isenburg, Germany
| | - Christian Jackisch
- Department of Obstetrics and Gynaecology, Breast Cancer Center, Offenbach, Germany
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69
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Aielli F, Giusti R, Rughetti A, dell'Orso L, Ficorella C, Porzio G. Rapid resolution of refractory chemotherapy-induced oral mucositis with platelet gel-released supernatant in a pediatric cancer patient: a case report. J Pain Symptom Manage 2014; 48:e2-4. [PMID: 25131890 DOI: 10.1016/j.jpainsymman.2014.06.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 06/21/2014] [Indexed: 10/24/2022]
Affiliation(s)
- Federica Aielli
- "L'Aquila per la Vita" Home Care Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Raffaele Giusti
- Medical Oncology Unit, Sant'Andrea Hospital-"Sapienza", University of Rome, Rome, Italy
| | - Anna Rughetti
- Division of Transfusion Medicine, Department of Health Sciences, "San Salvatore" Hospital, L'Aquila, Italy
| | - Luigi dell'Orso
- Division of Transfusion Medicine, Department of Health Sciences, "San Salvatore" Hospital, L'Aquila, Italy
| | - Corrado Ficorella
- Medical Oncology Department, University of L'Aquila, L'Aquila, Italy
| | - Giampiero Porzio
- "L'Aquila per la Vita" Home Care Unit, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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Bertoglio JC, Calderón S, Lesina B, Pilleux L, Morazzoni P, Riva A, Bombardelli E, Ronchi M, Cabri W, Petrangolini G. Effect of SAMITAL® in the treatment of chemotherapy-induced mucositis in adult oncohematological patients. Future Oncol 2014; 9:1727-32. [PMID: 24156332 DOI: 10.2217/fon.13.164] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
AIM We sought to evaluate the efficacy and safety of SAMITAL(®) (Indena SpA, Milan, Italy), a highly standardized botanical formulation, in reducing mucositis in patients undergoing treatment for hematological malignancies. PATIENTS & METHODS In this observational, uncontrolled study, a total of 25 consecutively enrolled patients (19 males, aged 18-74 years) with chemotherapy-induced mucositis were compassionately treated orally with SAMITAL (three to four times per day) for 4-22 days per cycle. RESULTS Patients demonstrated clinically relevant reductions in WHO mucositis grade with a reduction in pain, mucosal erosions, bleeding, dysphagia/feeding impairment and improvements in quality of life. SAMITAL was well tolerated and no local or systemic pharmacological, allergic, toxic or synergistic/antagonistic side effects were reported. Of note, SAMITAL also showed efficacy when administered prophylactically. CONCLUSION These results add weight to previous experiences with SAMITAL. However, randomized, placebo-controlled clinical trials will need to confirm the suitability of SAMITAL for use in the treatment of mucositis.
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71
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Morazzoni P, Petrangolini G, Bombardelli E, Ronchi M, Cabri W, Riva A. SAMITAL®: a new botanical drug for the treatment of mucositis induced by oncological therapies. Future Oncol 2014; 9:1717-25. [PMID: 24156331 DOI: 10.2217/fon.13.165] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
SAMITAL(®) (Indena SpA, Milan, Italy) is a new multicomponent and multiacting botanical formulation rationally designed for the relief of oral mucositis induced by chemotherapy and/or radiotherapy in oncological patients. Each of the individual botanical constituents of SAMITAL-standardized extracts of Vaccinium myrtillus, Macleaya cordata and Echinacea angustifolia have a long history of clinical use that corroborates their safety and activity in SAMITAL. A number of pilot trials in oncological patients demonstrated that SAMITAL has good clinical efficacy and tolerability as evidenced by its significant effects in terms of reduction of mucositis, pain and a general improvement in patient quality of life. Importantly, the use of this botanical formulation had the added benefit that patients were able to complete their chemotherapy/radiotherapy regimen. Phase II trials with SAMITAL as part of an overall clinical development program are currently ongoing in Italy and are planned in the USA.
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72
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Oral complications in hematopoietic stem cell recipients: the role of inflammation. Mediators Inflamm 2014; 2014:378281. [PMID: 24817792 PMCID: PMC4003795 DOI: 10.1155/2014/378281] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2013] [Accepted: 02/27/2014] [Indexed: 11/30/2022] Open
Abstract
Hematopoietic stem cell transplantation (HSCT) is widely used as a potentially curative treatment for patients with various hematological malignancies, bone marrow failure syndromes, and congenital immune deficiencies. The prevalence of oral complications in both autologous and allogeneic HSCT recipients remains high, despite advances in transplant medicine and in supportive care. Frequently encountered oral complications include mucositis, infections, oral dryness, taste changes, and graft versus host disease in allogeneic HSCT. Oral complications are associated with substantial morbidity and in some cases with increased mortality and may significantly affect quality of life, even many years after HSCT. Inflammatory processes are key in the pathobiology of most oral complications in HSCT recipients. This review article will discuss frequently encountered oral complications associated with HSCT focusing on the inflammatory pathways and inflammatory mediators involved in their pathogenesis.
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Abstract
Oral mucositis is a significant toxicity of systemic chemotherapy and of radiation therapy to the head and neck region. The morbidity of oral mucositis can include pain, nutritional compromise, impact on quality of life, alteration in cancer therapy, risk for infection, and economic costs. Management includes general symptomatic support and targeted therapeutic interventions for the prevention or treatment of oral mucositis. Evidence-based clinical practice guidelines are available to guide clinicians in the selection of effective management strategies.
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Affiliation(s)
- Rajesh V Lalla
- Section of Oral Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-1605, USA.
| | - Deborah P Saunders
- Department of Dental Oncology, Northeast Cancer Centre, Health Sciences North, Northern Ontario School of Medicine, 41 Ramsey Lake Road, Sudbury, ON P3E 5J1, Canada
| | - Douglas E Peterson
- Section of Oral Medicine, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030-1605, USA
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Horii K, Kanayama T, Miyamoto H, Kohgo T, Tsuchimochi T, Shigetomi T, Yokoi M. Platelet-rich fibrin has a healing effect on chemotherapy-induced mucositis in hamsters. Oral Surg Oral Med Oral Pathol Oral Radiol 2014; 117:445-53. [DOI: 10.1016/j.oooo.2013.12.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Revised: 11/30/2013] [Accepted: 12/04/2013] [Indexed: 10/25/2022]
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75
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Radioprotection of normal tissue cells. Strahlenther Onkol 2014; 190:745-52. [DOI: 10.1007/s00066-014-0637-x] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 02/05/2014] [Indexed: 12/13/2022]
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76
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Lalla RV, Bowen J, Barasch A, Elting L, Epstein J, Keefe DM, McGuire DB, Migliorati C, Nicolatou-Galitis O, Peterson DE, Raber-Durlacher JE, Sonis ST, Elad S. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy. Cancer 2014; 120:1453-61. [PMID: 24615748 PMCID: PMC4164022 DOI: 10.1002/cncr.28592] [Citation(s) in RCA: 688] [Impact Index Per Article: 68.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Revised: 11/21/2013] [Accepted: 12/20/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Mucositis is a highly significant, and sometimes dose‐limiting, toxicity of cancer therapy. The goal of this systematic review was to update the Multinational Association of Supportive Care in Cancer and International Society of Oral Oncology (MASCC/ISOO) Clinical Practice Guidelines for mucositis. METHODS A literature search was conducted to identify eligible published articles, based on predefined inclusion/exclusion criteria. Each article was independently reviewed by 2 reviewers. Studies were rated according to the presence of major and minor flaws as per previously published criteria. The body of evidence for each intervention, in each treatment setting, was assigned a level of evidence, based on previously published criteria. Guidelines were developed based on the level of evidence, with 3 possible guideline determinations: recommendation, suggestion, or no guideline possible. RESULTS The literature search identified 8279 papers, 1032 of which were retrieved for detailed evaluation based on titles and abstracts. Of these, 570 qualified for final inclusion in the systematic reviews. Sixteen new guidelines were developed for or against the use of various interventions in specific treatment settings. In total, the MASCC/ISOO Mucositis Guidelines now include 32 guidelines: 22 for oral mucositis and 10 for gastrointestinal mucositis. This article describes these updated guidelines. CONCLUSIONS The updated MASCC/ISOO Clinical Practice Guidelines for mucositis will help clinicians provide evidence‐based management of mucositis secondary to cancer therapy. Cancer 2014;120:1453–1461. © 2014 The Authors. Cancer published by Wiley Periodicals, Inc. on behalf of American Cancer Society. Mucositis is a highly significant, and sometimes dose‐limiting, toxicity of cancer therapy. This article presents evidence‐based clinical practice guidelines for the management of mucositis.
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77
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Campos MIDAC, Campos CN, Aarestrup FM, Aarestrup BJV. Oral mucositis in cancer treatment: Natural history, prevention and treatment. Mol Clin Oncol 2014; 2:337-340. [PMID: 24772297 DOI: 10.3892/mco.2014.253] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 01/20/2014] [Indexed: 11/05/2022] Open
Abstract
Oral mucositis is a condition that is characterized by ulcerative lesions in the mucosa of patients undergoing radiotherapy or chemotherapy. Oral mucositis is currently considered to be the most severe complication of anticancer therapy, affecting 40-80% of patients undergoing chemotherapy and almost all those undergoing radiotherapy of the head and neck. Although they do not prevent lesions from appearing, drugs for the treatment of oral mucositis are required to minimize its clinical aggressiveness and improve the nutritional status, hydration and quality of life of the affected patients. Furthermore, the prevention and control of oral ulcers is crucial for cancer prognosis, since the establishment of severe lesions may lead to temporary or permanent treatment discontinuation and compromise cancer control. The objective of this study was to present a review on this condition, its causes and its treatment to professional clinical dentists, in order to help minimize patient suffering. A search was conducted through PubMed, Lilacs and MedLine, to retrieve related articles published between 1994 and 2013.
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Affiliation(s)
- Maria Ines DA Cruz Campos
- Postgraduate Programme in Brazilian Health, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Celso Neiva Campos
- Department of Dental Clinic, Dental School, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Fernando Monteiro Aarestrup
- Laboratory of Immunopathology and Clinical Immunology, Federal University of Juiz de Fora, Minas Gerais, Brazil
| | - Beatriz Julião Vieira Aarestrup
- Department of Morphology (Histology and Embryology), Institute of Biological Sciences Research, Federal University of Juiz de Fora, Minas Gerais, Brazil
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Alvariño-Martín C, Sarrión-Pérez MG. Prevention and treatment of oral mucositis in patients receiving chemotherapy. J Clin Exp Dent 2014; 6:e74-80. [PMID: 24596640 PMCID: PMC3935910 DOI: 10.4317/jced.51313] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 11/21/2013] [Indexed: 12/20/2022] Open
Abstract
Oral mucositis is one of the most common side effects of cancer treatment (chemotherapy and/or radiotherapy). It is an inflammatory process that affects the mucosa of the oral cavity, giving rise to erythematous areas in combination with ulcers that can reach a large size. The true importance of oral mucositis is the complications it causes - fundamentally intense pain associated to the oral ulcers, and the risk of overinfection. This in turn may require reduction or even suspension of the antineoplastic treatment, with the risk of seriously worsening the patient prognosis. This points to the importance of establishing therapeutic tools of use in the prevention and/or treatment of mucositis. The present study offers a literature review of all the articles published over the last 10 years referred to the prevention and/or treatment of oral mucositis associated to chemotherapy. Key words:Oral mucositis, management, prevention, treatment, chemotherapy.
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Affiliation(s)
- Carlos Alvariño-Martín
- Dentistry, Master of Oral Medicine and Oral Surgery, Faculty of Medicine and Dentistry, University of Valencia, Spain
| | - Maria G Sarrión-Pérez
- Adjunt Professor of the Department of Stomatology, Faculty of Medicine and Dentistry, University of Valencia, Spain
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Wardill HR, Bowen JM, Gibson RJ. New pharmacotherapy options for chemotherapy-induced alimentary mucositis. Expert Opin Biol Ther 2014; 14:347-54. [PMID: 24387716 DOI: 10.1517/14712598.2014.874412] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Chemotherapy-induced alimentary mucositis is an extremely common condition that is caused by a breakdown of the mucosal barrier. It occurs in between 40 - 100% of cancer patients depending on the treatment regimen. Symptoms typically include pain from oral ulceration, vomiting and diarrhoea. Alimentary mucositis often necessitates chemotherapy reductions or treatment breaks, overall potentially compromising survival outcomes. Consequently, alimentary mucositis creates a burden not only on patients' quality of life but also on healthcare costs. Despite this, currently, there is no clinically effective localised/pharmacological therapy intervention strategy to prevent alimentary mucositis. AREAS COVERED Over recent years, a number of novel pharmacotherapy agents have been trialed in various preclinical and clinical settings. This critical review will therefore provide an overview of emerging pharmacotherapies for the treatment of alimentary mucositis following chemotherapy with particular emphasis on studies published in the last 2 years. A Pubmed literature search was conducted to identify eligible articles published before 30 November 2013 and each article was reviewed by all authors. All articles were written in English. EXPERT OPINION Currently, there is no clinically effective localised therapeutic intervention strategy to prevent the condition. New emerging areas of research have recently been proposed to play key roles in the development of alimentary mucositis and these areas may provide researchers and clinicians with new research directions. Hopefully this will continue, and evidence-based informed guidelines can be produced to improve clinical practice management of this condition.
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Affiliation(s)
- Hannah R Wardill
- University of Adelaide, School of Medical Sciences, Discipline of Anatomy and Pathology , Adelaide , Australia
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80
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Jensen SB, Peterson DE. Oral mucosal injury caused by cancer therapies: current management and new frontiers in research. J Oral Pathol Med 2013; 43:81-90. [PMID: 24261541 DOI: 10.1111/jop.12135] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2013] [Indexed: 01/17/2023]
Abstract
This invited update is designed to provide a summary of the state-of-the-science regarding oral mucosal injury (oral mucositis) caused by conventional and emerging cancer therapies. Current modeling of oral mucositis pathobiology as well as evidence-based clinical practice guidelines for prevention and treatment of oral mucositis are presented. In addition, studies addressing oral mucositis as published in the Journal of Oral Pathology and Medicine 2008-2013 are specifically highlighted in this context. Key research directions in basic and translational science associated with mucosal toxicity caused by cancer therapies are also delineated as a basis for identifying pathobiologic and pharmacogenomic targets for interventions. This collective portfolio of research and its ongoing incorporation into clinical practice is setting the stage for the clinician in the future to predict mucosal toxicity risk and tailor therapeutic interventions to the individual oncology patient accordingly.
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Affiliation(s)
- Siri B Jensen
- Section of Oral Medicine, Clinical Oral Physiology, Oral Pathology & Anatomy, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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81
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The MASCC/ISOO mucositis guidelines: dissemination and clinical impact. Support Care Cancer 2013; 21:3161-3. [PMID: 23942597 DOI: 10.1007/s00520-013-1924-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 07/31/2013] [Indexed: 10/26/2022]
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82
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Jensen SB, Jarvis V, Zadik Y, Barasch A, Ariyawardana A, Hovan A, Yarom N, Lalla RV, Bowen J, Elad S. Systematic review of miscellaneous agents for the management of oral mucositis in cancer patients. Support Care Cancer 2013; 21:3223-32. [PMID: 23900593 DOI: 10.1007/s00520-013-1884-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2013] [Accepted: 06/19/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The aim of this systematic review was to analyze the available literature and define clinical practice guidelines for the use of the following agents for the prevention and treatment of oral mucositis (OM): allopurinol, midline mucosa-sparing radiation blocks, payayor, pentoxifylline, timing of radiation therapy (RT) (morning versus late afternoon), pilocarpine, bethanechol, chewing gum, propantheline, and tetrachlorodecaoxide. METHODS A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, no guideline possible. RESULTS A total of 32 papers across 10 interventions were examined. New suggestions were developed against the use of systemic pilocarpine administered orally for prevention of OM during RT in head and neck cancer patients and in patients receiving high-dose chemotherapy, with or without total body irradiation, prior to hematopoietic stem cell transplantation. A suggestion was also made against the use of systemic pentoxifylline administered orally for the prevention of OM in patients undergoing bone marrow transplantation. No guideline was possible for any other agent reviewed due to inadequate and/or conflicting evidence. CONCLUSIONS None of the agents reviewed was determined to be effective for the prevention or treatment of OM. Two agents, pilocarpine and pentoxifylline, were determined to be ineffective, in the populations listed above. Additional well-designed research is needed on other interventions.
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Affiliation(s)
- Siri Beier Jensen
- Section of Oral Medicine, Clinical Oral Physiology, Oral Pathology and Anatomy, Department of Odontology, Faculty of Health and Medical Sciences, University of Copenhagen, Nørre Allé 20, 2200 N, Copenhagen, Denmark,
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Epstein JB. Personalized medicine: predicting the risk of complications of cancer therapy. Oral Dis 2013; 19:633-4. [DOI: 10.1111/odi.12147] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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