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Guan C, Lu T, Liao Z, Rich E, Gong X, Lv Q, Li J. Nutritional Status and Incidence of Radiation-Induced Oral Mucositis in Nasopharyngeal Carcinoma Patients Treated with Chemoradiotherapy. Nutr Cancer 2024; 76:196-206. [PMID: 38113055 DOI: 10.1080/01635581.2023.2294523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 12/03/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
Malnutrition is prevalent among patients with nasopharyngeal carcinoma undergoing radiotherapy. This study examined the nutritional status and incidence of radiation-induced oral mucositis (RIOM) in patients with nasopharyngeal carcinoma. A retrospective analysis was conducted to compare the incidence of RIOM, Nutritional Risk Screening (NRS) 2002 score, weight, body mass index (BMI), and hemoglobin levels in 338 patients treated with induction chemotherapy (IC) plus concurrent chemoradiotherapy (CCRT) or treated with CCRT alone. The IC + CCRT group exhibited an increase in weight and BMI but a decrease in hemoglobin levels after IC compared with baseline (p < 0.001). Both groups showed differences in weight at Week 0 and BMI at Weeks 0-2 of radiotherapy (p < 0.05). The IC + CCRT group experienced an increase in NRS 2002 scores from Week 2 to Week 6 (p < 0.05). The hemoglobin levels of the IC + CCRT group were consistently lower throughout radiotherapy (p < 0.001). However, no significant difference was observed in the incidence of RIOM between the two groups (p = 0.246). Patients treated with IC + CCRT exhibited a higher nutritional risk during radiotherapy. Although the incidence of Grade III RIOM was high, no significant difference was found between the groups.
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Affiliation(s)
- Chunhong Guan
- NHC Key Laboratory of Personalized Diagnosis and Treatment for Nasopharyngeal Carcinoma, the Second Affiliated Hospital of Nanchang Medical College (Jiangxi Cancer Hospital), Nanchang, Jiangxi, China
- Jiangxi Key Laboratory of Translational Research for Cancer, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China
| | - Tianzhu Lu
- NHC Key Laboratory of Personalized Diagnosis and Treatment for Nasopharyngeal Carcinoma, the Second Affiliated Hospital of Nanchang Medical College (Jiangxi Cancer Hospital), Nanchang, Jiangxi, China
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China
| | - Zhaohui Liao
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China
- Nursing School of Nanchang University, Nanchang, Jiangxi, China
- Clinical Training Center, Jiangxi Cancer Hospital, the Second Affiliated Hospital of Nanchang Medical College, Nanchang, Jiangxi, China
| | - Emily Rich
- Centre for Public Health, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Xiaochang Gong
- NHC Key Laboratory of Personalized Diagnosis and Treatment for Nasopharyngeal Carcinoma, the Second Affiliated Hospital of Nanchang Medical College (Jiangxi Cancer Hospital), Nanchang, Jiangxi, China
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China
| | - Qiaoli Lv
- Jiangxi Key Laboratory of Translational Research for Cancer, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China
| | - Jingao Li
- NHC Key Laboratory of Personalized Diagnosis and Treatment for Nasopharyngeal Carcinoma, the Second Affiliated Hospital of Nanchang Medical College (Jiangxi Cancer Hospital), Nanchang, Jiangxi, China
- Department of Radiation Oncology, Jiangxi Cancer Hospital, Nanchang, Jiangxi, China
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Nayak SG, George A, Sharan K, Nayak BS, Salins N. Interventions to improve quality of life in patients with head and neck cancers receiving radiation therapy: a scoping review. Support Care Cancer 2023; 32:31. [PMID: 38102525 DOI: 10.1007/s00520-023-08197-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 11/20/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Quality of life (QOL) is impaired in patients with head and neck cancers (HNC) due to illness and treatment-associated morbidity. Although there is evidence from the studies on interventions' role in improving QOL receiving radiation therapy, these are not systematically synthesised. In this scoping review, we searched and synthesised the evidence on interventions to improve the QOL and its impact among patients with HNCs. METHODS This scoping review was conducted using the framework proposed by Arksey and O'Malley, and the extensions suggested by Levac et al. were incorporated. Two reviewers independently searched four electronic databases using key thesaurus and free-text terms, and the data was extracted, tabulated, synthesised and reported as categories. RESULTS Seventy-nine papers reported various interventions of diverse nature such as pharmacological, physical, nutritional, complementary and alternative therapies, psychosocial, oral care related, laser and photobiomodulation therapies, rehabilitative, educational, technology-based, surgical, device-related and nurse lead interventions. Most studies reported clinically meaningful impact of interventions on QOL, although the outcome differences were often statistically insignificant. Few studies reported a combination of interventions to address the multidimensional concerns faced by patients with HNCs. None of the studies examined the impact of interventions on QOL among long-term survivors of HNCs. CONCLUSION As QOL concerns in patients with HNCs are multifaceted, more extensive studies with complex multi-component interventions and robust research designs are warranted.
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Affiliation(s)
- Shalini Ganesh Nayak
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Anice George
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Krishna Sharan
- Radiotherapy & Oncology, KS Hegde Medical Academy, Nitte (Deemed to Be University), Mangalore, Karnataka, India
| | - Baby S Nayak
- Department of Child Health Nursing, Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Naveen Salins
- Department of Palliative Medicine and Supportive Care, Kasturba Medical College Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Kuroki K, Rikimaru F, Kunitake N, Toh S, Higaki Y, Masuda M. Efficacy of beta-hydroxy-beta-methylbutyrate, arginine, and glutamine for the prevention of mucositis induced by platinum-based chemoradiation in head and neck cancer: A phase II study. Clin Nutr ESPEN 2023; 57:730-734. [PMID: 37739730 DOI: 10.1016/j.clnesp.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/09/2023] [Accepted: 08/23/2023] [Indexed: 09/24/2023]
Abstract
BACKGROUND & AIMS The current standard treatment modality for advanced head and neck squamous cell carcinoma (HNSCC), namely platinum-based (PB) concurrent chemoradiotherapy (CRT), is associated with frequent severe mucositis which is responsible for the multiple acute and late adverse events. So far, effective preventive methods for this CRT-induced mucositis are not identified. In the current study, we examined the prophylactic effects of beta-hydroxy-beta-methylbutyrate (HMB), arginine (Arg), and glutamine (Gln) (HMB/Arg/Gln) mixture. METHODS Patients with HNSCC who were subject to PBCRT were randomly assigned to HMB/Arg/Gln intervention (Group I) and non-intervention (Group NI) cohort. The incidences of ≧ grade 3 mucositis (primary endpoint), ≧ grade 2 mucositis, and opioid usage and the degree of body weight loss (secondary endpoints) were compared between Group I and Group NI. RESULTS A total of 75 patients were enrolled to this study and 38 patients were assigned to Group I, while 37 patients were to Group NI. After excluding patients who failed to complete CRT (3 in Group I and 2 in Group NI) or withdrew consents (11 in Group I and 1 in Group NI), 24 patients in Group I and 34 patients in Group NI were evaluated. HMB/Arg/Gln failed to reduce the incidences of ≧ grade 2 mucositis, but significantly (p = 0.0003) inhibited grade 3 mucositis in the late phase CRT, reducing the incidence from 64.6% (Group NI) to 25% (Group I) at 70Gy. The degree of body weight loss was significantly (p = 0.0038) lower in Group I (5.6%) compared to Group NI (8.9%), preventing the progression of PBCRT-induced cachexia. CONCLUSIONS HMB/Arg/Gln administration demonstrated inhibitory effects on the progression of grade 3 mucositis and cancer cachexia in HNSCC patients treated with PBCRT. A larger scale phase III study is encouraged. CLINICAL TRIAL REGISTRATION This study is registered to the UMIN Clinical Trial Registry: UMIN000050011.
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Affiliation(s)
- Keiji Kuroki
- Department of Head and Neck Surgery, National Hospital Organization Kyushu Cancer Center, Notame 3-1-1, Minami-ku, Fukuoka, 811-1395, Japan
| | - Fumihide Rikimaru
- Department of Head and Neck Surgery, National Hospital Organization Kyushu Cancer Center, Notame 3-1-1, Minami-ku, Fukuoka, 811-1395, Japan
| | - Naonobu Kunitake
- Department of Radiology, National Hospital Organization Kyushu Cancer Center, Notame 3-1-1, Minami-ku, Fukuoka, 811-1395, Japan
| | - Satoshi Toh
- Department of Head and Neck Surgery, National Hospital Organization Kyushu Cancer Center, Notame 3-1-1, Minami-ku, Fukuoka, 811-1395, Japan
| | - Yuichiro Higaki
- Department of Head and Neck Surgery, National Hospital Organization Kyushu Cancer Center, Notame 3-1-1, Minami-ku, Fukuoka, 811-1395, Japan
| | - Muneyuki Masuda
- Department of Head and Neck Surgery, National Hospital Organization Kyushu Cancer Center, Notame 3-1-1, Minami-ku, Fukuoka, 811-1395, Japan.
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Yokota T, Ueno T, Soga Y, Ishiki H, Uezono Y, Mori T, Zenda S, Uchitomi Y. J-SUPPORT research policy for oral mucositis associated with cancer treatment. Cancer Med 2022; 11:4816-4829. [PMID: 35691025 PMCID: PMC9761062 DOI: 10.1002/cam4.4811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/22/2022] [Accepted: 04/26/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Oral mucositis is one of the main areas of research in supportive and palliative care of cancer patients. However, the methodology of prospective clinical trials on oral mucositis has not been established, despite its uniqueness. Here, we propose a novel research policy on oral mucositis, including an implementable set of recommendations for researchers conducting clinical trials. METHODS The first draft was developed by an expert panel of six specialists from the Japanese Supportive, Palliative, and Psychosocial Care Study Group. A provisional draft was developed after review by the following medical societies: the Japanese Association of Supportive Care in Cancer, the Japanese Association of Oral Supportive Care in Cancer, the Japanese Cancer Association, and the receipt of public comments. RESULTS The research policy on oral mucositis mainly consists of the following components: (i) definition of oral mucositis; (ii) characteristics of oral mucositis; (iii) characteristics of oral mucositis research; (iv) target population for oral mucositis research; (v) endpoints and assessment measures in oral mucositis; (vi) eligibility criteria; (vii) research design; (viii) minimally recommended intervention in oral mucositis research as a supplement. The final policy (Ver1.0) was completed on August 16, 2021. CONCLUSIONS This policy may serve as a significant reference for planning and conducting clinical trials for the management of oral mucositis.
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Affiliation(s)
- Tomoya Yokota
- Division of Gastrointestinal OncologyShizuoka Cancer CenterSunto‐gunJapan
| | - Takao Ueno
- Department of General Internal Medicine, Dentistry, Oncologic EmergencyNational Cancer Center HospitalTokyoJapan
| | - Yoshihiko Soga
- Division of Hospital DentistryOkayama University HospitalOkayamaJapan
| | - Hiroto Ishiki
- Department of Palliative MedicineNational Cancer Center HospitalTokyoJapan
| | - Yasuhito Uezono
- Department of Pain Control ResearchThe Jikei University School of MedicineTokyoJapan
- Supportive and Palliative Care Research Support OfficeNational Cancer Center Hospital EastKashiwaJapan
- Project for Supportive Care Research, Exploratory Oncology Research and Clinical Trial CenterNational Cancer CenterKashiwaJapan
| | - Takehiko Mori
- Department of HematologyTokyo Medical and Dental UniversityTokyoJapan
| | - Sadamoto Zenda
- Supportive and Palliative Care Research Support OfficeNational Cancer Center Hospital EastKashiwaJapan
- Department of Radiation OncologyNational Cancer Center Hospital EastKashiwaJapan
| | - Yosuke Uchitomi
- Innovation Center for Supportive, Palliative and Psychosocial CareNational Cancer Center HospitalTokyoJapan
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Prado CM, Orsso CE, Pereira SL, Atherton PJ, Deutz NEP. Effects of β-hydroxy β-methylbutyrate (HMB) supplementation on muscle mass, function, and other outcomes in patients with cancer: a systematic review. J Cachexia Sarcopenia Muscle 2022; 13:1623-1641. [PMID: 35301826 PMCID: PMC9178154 DOI: 10.1002/jcsm.12952] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 02/01/2022] [Indexed: 12/17/2022] Open
Abstract
Low muscle mass is prevalent among patients with cancer and a predictor of adverse clinical outcomes. To counteract muscle loss, β-hydroxy β-methylbutyrate (HMB) supplementation has been proposed as a potential therapy for older adults and various diseases states. This systematic review aimed to investigate the effects and safety of HMB supplementation in relation to muscle mass and function and other clinical outcomes in patients with cancer. A systematic search of MEDLINE, CINAHL, Embase, Cochrane Central Register of Controlled Trials, Scopus, ProQuest, and grey literature for reports published from inception to December 2021 was conducted. Included studies provided supplements containing any dose of HMB to adult patients with active cancer. A synthesis without meta-analysis was conducted using a vote-counting approach based solely on the direction of the effect (i.e. regardless of statistical significance). Risk of bias was assessed for each outcome domain, and evidence from higher-quality studies (i.e. those with either low or moderate risk of bias) was examined. Safety was evaluated using both lower-quality and higher-quality studies. Fifteen studies were included, in which six were randomized controlled trials in patients with various cancer types and treatments. Studies prescribed HMB combined with amino acids (73.3%), HMB in oral nutritional supplements (20.0%), or both supplement types (6.7%); Ca-HMB doses of 3.0 g/day were provided in 80.0% of the studies. Four studies had high risk of bias across all outcome domains. Considering the higher-quality studies, evidence of a beneficial effect of HMB supplementation was found in four of four studies for muscle mass, two of two for muscle function, three of three for hospitalization, and five of seven for survival. In contrast, no beneficial effects of HMB on quality of life or body weight was found in two of four and three of five studies, respectively. A limited number of higher-quality studies evaluating the impact of HMB on cancer therapy-related toxicity, inflammation, and tumour response were observed. No serious adverse effects directly related to the nutrition intervention were reported. Although limited, current evidence suggests that HMB supplementation has a beneficial effect on muscle mass and function in patients with cancer. Well-designed trials are needed to further explore the clinical benefit of HMB supplementation in this patient population.
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Affiliation(s)
- Carla M Prado
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | - Camila E Orsso
- Human Nutrition Research Unit, Department of Agricultural, Food and Nutritional Science, University of Alberta, Edmonton, AB, Canada
| | | | - Philip J Atherton
- Centre of Metabolism, Ageing & Physiology (COMAP), Medical Research Council (MRC) Versus Arthritis Centre for Musculoskeletal Ageing Research (CMAR), and National Institute for Health Research (NIHR) Biomedical Research Centre (BRC), University of Nottingham, Nottingham, UK
| | - Nicolaas E P Deutz
- Center for Translational Research in Aging and Longevity, Department of Health and Kinesiology, Texas A&M University, College Station, TX, USA
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Isozaki AB, Brant JM. Clinical Updates in Mucositis-Related Symptom Management. Semin Oncol Nurs 2022; 38:151252. [DOI: 10.1016/j.soncn.2022.151252] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Dvoretskiy S, Pereira SL, Das T. Efficacy of Nutrients in Reducing the Symptoms of Radiation Induced Oral Mucositis in a Hamster Model. Nutr Cancer 2021; 74:1079-1089. [PMID: 34282686 DOI: 10.1080/01635581.2021.1952440] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Radiation-induced oral mucositis (RIOM) is a painful, dose-limiting toxicity in cancer therapy. RIOM was induced by radiation on the left buccal pouch mucosa of Golden Syrian hamsters (n = 8/group). Animals were treated topically with polyphenols (Curcumin or Quercetin) or amino acids/metabolite mixtures (Alanyl-Glutamine or Arginine + Glutamine + β-Hydroxy β-methylbutyric acid (Arg/Gln/HMB)) for over 20 day. Progression of RIOM was assessed using a standard visual scoring six-point scale, for differences in severity of mucositis (score ≥3) (Chi-square analysis) and in the daily group scores (Mann-Whitney rank sum test). Compared to the controls, there was a significant reduction in number of days with severe RIOM (score ≥3) in the treatment groups: Curcumin (50 μg/ml) = 17%; Control = 38.5%, p < 0.001; Quercetin (50 μg/ml) = 27.6% and Quercetin (100 μg/ml) = 25%; Control = 41.3%, p = 0.007 and p = 0.001, respectively; Arg/Gln/HMB (50 mg/ml) = 31.9%; Control = 50.0%, p = 0.040. In addition, Curcumin (50 μg/ml), Quercetin (100 μg/ml) and Arg/Gln/HMB (100 mg/ml) groups had lower mucositis scores (≥3) on at least two consecutive time points over the course of the study than their respective controls. There were no significant group differences in deaths or body weight. This study demonstrates the potential benefits of topical application of either plant polyphenols or amino acid/metabolite mixtures in addressing severity and progression of RIOM.
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Affiliation(s)
| | - Suzette L Pereira
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, Ohio, USA
| | - Tapas Das
- Scientific and Medical Affairs, Abbott Nutrition, Columbus, Ohio, USA
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Pascoe J, Jackson A, Gaskell C, Gaunt C, Thompson J, Billingham L, Steven N. Beta-hydroxy beta-methylbutyrate/arginine/glutamine (HMB/Arg/Gln) supplementation to improve the management of cachexia in patients with advanced lung cancer: an open-label, multicentre, randomised, controlled phase II trial (NOURISH). BMC Cancer 2021; 21:800. [PMID: 34247580 PMCID: PMC8274132 DOI: 10.1186/s12885-021-08519-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/17/2021] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Cancer cachexia causes significant morbidity and mortality in advanced lung cancer patients. Clinical benefit of β-hydroxy-β-methylbutyrate, arginine, and glutamine (HMB/Arg/Gln) was assessed in newly diagnosed patients. METHODS NOURISH, a prospective, two-arm, open-label, multi-centre, randomised controlled phase II trial compared cachexia in patients who received HMB/Arg/Gln with those who did not. All patients received structured nutritional, exercise and symptom control via a Macmillan Durham Cachexia Pack. Conducted in five UK centres, patients aged > 18 years, with newly diagnosed advanced small cell lung cancer (SCLC) or non-small cell lung cancer (NSCLC), who were able to take oral nutrition, with a performance status of 0-to-2 and a life expectancy > 4 months were eligible for trial entry. Patients suitable for treatment with curative intent were ineligible. The trial was designed as a signal-seeking pilot study with target recruitment of 96 patients. One-to-one randomisation was stratified by diagnosis (SCLC or NSCLC), stage of disease (locally advanced or metastatic) and performance status. The primary outcome measure was treatment success defined as a patient being alive without significant loss of lean body mass (not > 5%) by 12 weeks. Secondary outcome measures included quality of life. RESULTS Between February-2012 and February-2013, 38 patients were recruited, 19 to each arm. Baseline characteristics were balanced. The trial was halted due to slow accrual and partial adherence. Trial data demonstrated no evidence of treatment benefit. No serious adverse events were reported during the trial. CONCLUSIONS Further evaluation of HMB/Arg/Gln in this setting could not be recommended on the basis of this trial. CLINICAL TRIAL REGISTRATION ISRCTN registry: 39911673; 14-Apr-2011 https://doi.org/10.1186/ISRCTN39911673 .
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Affiliation(s)
- Jennifer Pascoe
- Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Aimee Jackson
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Charlotte Gaskell
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Claire Gaunt
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Joyce Thompson
- Birmingham Heartlands Hospital, Bordesley Green E, Birmingham, B9 5SS, UK
| | - Lucinda Billingham
- Cancer Research UK Clinical Trials Unit (CRCTU), University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK.
| | - Neil Steven
- Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Judge LF, Farrugia MK, Singh AK. Narrative review of the management of oral mucositis during chemoradiation for head and neck cancer. ANNALS OF TRANSLATIONAL MEDICINE 2021; 9:916. [PMID: 34164550 PMCID: PMC8184418 DOI: 10.21037/atm-20-3931] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 12/31/2020] [Indexed: 12/31/2022]
Abstract
Oral mucositis (OM) can be a significant problem for patients undergoing radiation or chemoradiation for head and neck cancer. In modern clinical trials, grade 3-4 OM can be seen in over 40% of patients and can cause a significant impact on their quality of life (QOL). Despite this fact, strategies for the prevention and treatment of OM vary widely, with options including both lifestyle modifications and pharmaceuticals. Here we evaluate and summarize the current clinical interventions for the management of radiation-induced OM. The majority of the current evidence focuses on reducing OM related pain. These agents are detailed over multiple clinical trials including treatment modalities such as: GC4419, doxepin mouthwash, diphenhydramine-lidocaine-antacid (DLA) mouthwash, gabapentin, and methadone. While several strategies have been employed to prevent radiation-induced OM, there is currently no strong evidence for the routine use of these agents in the clinic. After summarization of these treatments, we offer practical guidance for the treatment of OM in the clinic. We recommend a multiagent approach of pharmacological and non-pharmacological treatments including oral rinses, home humidification, escalating doses of gabapentin, doxepin or DLA mouthwash, over the counter analgesics, and lastly methadone. These interventions are tailored to address the expected increase of severity of symptoms during the course of head and neck radiotherapy.
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Affiliation(s)
- Lauren F. Judge
- Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA
| | - Mark K. Farrugia
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
| | - Anurag K. Singh
- Department of Radiation Medicine, Roswell Park Comprehensive Cancer Center, Buffalo, NY, USA
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Edwards A, Santos C, Chen A, Bauer J. Nutritional interventions for oral mucositis: a systematic literature review. Nutr Diet 2021. [DOI: 10.1111/1747-0080.12656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- Anna Edwards
- School of Human Movement and Nutrition Sciences The University of Queensland Queensland Australia
- Department of Nutrition and Dietetics Toowoomba Hospital Toowoomba Queensland Australia
| | - Claire Santos
- School of Human Movement and Nutrition Sciences The University of Queensland Queensland Australia
- Department of Nutrition and Dietetics Princess Alexandra Hospital Brisbane Queensland Australia
| | - An‐Yang Chen
- Department of Nutrition and Dietetics Royal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Judith Bauer
- School of Human Movement and Nutrition Sciences The University of Queensland Queensland Australia
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Karna E, Szoka L, Huynh TYL, Palka JA. Proline-dependent regulation of collagen metabolism. Cell Mol Life Sci 2020; 77:1911-1918. [PMID: 31740988 PMCID: PMC7228914 DOI: 10.1007/s00018-019-03363-3] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 10/17/2019] [Accepted: 10/30/2019] [Indexed: 12/27/2022]
Abstract
This review is focused on recent data on the role of proline (Pro) in collagen biosynthesis and cellular metabolism. It seems obvious that one of the main substrates for collagen biosynthesis Pro is required to form collagen molecule. The question raised in this review is whether the Pro for collagen biosynthesis is synthesized "de novo", comes directly from degraded proteins or it is converted from other amino acids. Recent data provided evidence that extracellular Pro (added to culture medium) had significant, but relatively little impact on collagen biosynthesis in fibroblasts (the main collagen synthesized cells) cultured in the presence of glutamine (Gln). However, extracellular Pro drastically increased collagen biosynthesis in the cells cultured in Gln-free medium. It suggests that Pro availability determines the rate of collagen biosynthesis and demand for Pro in fibroblasts is predominantly met by conversion from Gln. The potential mechanism of this process as well as possible implication of this knowledge in pharmacotherapy of connective tissue diseases is discussed in this review.
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Affiliation(s)
- Ewa Karna
- Department of Medicinal Chemistry, Medical University of Bialystok, Mickiewicza 2 D, 15-222, Białystok, Poland
| | - Lukasz Szoka
- Department of Medicinal Chemistry, Medical University of Bialystok, Mickiewicza 2 D, 15-222, Białystok, Poland
| | - Thi Yen Ly Huynh
- Department of Medicinal Chemistry, Medical University of Bialystok, Mickiewicza 2 D, 15-222, Białystok, Poland
| | - Jerzy A Palka
- Department of Medicinal Chemistry, Medical University of Bialystok, Mickiewicza 2 D, 15-222, Białystok, Poland.
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Ludwig C, Goh V, Rajkumar J, Au J, Tsoukas M. Drug eruptions associated with tumor therapy: Great imitators. Clin Dermatol 2019; 38:208-215. [PMID: 32513400 DOI: 10.1016/j.clindermatol.2019.10.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Many studies have investigated cutaneous reactions to antitumor drugs and found them to be quite numerous. We describe drug eruptions that may be associated with different therapies by class: antimetabolite chemotherapeutics, genotoxic agents, spindle inhibitors, signal transduction inhibitors, and immunotherapies. Methotrexate is most often associated with mucocutaneous reactions, alkylating antimetabolite agents with hyperpigmentation, and platinum antimetabolite agents with type I IgE-mediated hypersensitivity reactions. Anthracycline derivatives can induce the hand-foot syndrome in patients, and bleomycin is associated with a bleomycin-induced flagellate erythema. Taxane spindle inhibitors can result in acneiform eruptions, which may also be seen with use of epidermal growth factor receptor inhibitors. Imatinib and its derivatives can cause a truncal maculopapular eruption, whereas multikinase inhibitors can produce a hand-foot-skin reaction. Vemurafenib can result in squamous cell carcinomas and photosensitivity. First-generation mammalian target of rapamycin inhibitors may cause a maculopapular eruption initially involving the face and neck. Programmed death (PD)-1-ligand and receptor inhibitors are associated with bullous pemphigoid. Ipilimumab, targeting Cytotoxic -T- Lymphocyte- associated (CTLA-4) receptors, can cause a morbilliform reaction, whereas Interleukin -2 (IL-2) analogs can create the capillary leak syndrome. Chemotherapeutic drug eruptions classically can manifest in the aforementioned ways; however, it is important to understand that they are associated with myriad cutaneous adverse effects, which may be mistaken for organic skin disease. Oncologists prescribing these medications should be familiar with the cutaneous side effects of these medications, and so they may counsel patients to be on the lookout for them.
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Affiliation(s)
- Catherine Ludwig
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Vivien Goh
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Jeffrey Rajkumar
- University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Jeremiah Au
- Department of Dermatology, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA
| | - Maria Tsoukas
- Department of Dermatology, University of Illinois College of Medicine at Chicago, Chicago, Illinois, USA.
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13
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Naganuma A, Hoshino T, Ohno N, Ogawa Y, Murakami T, Horiguchi S, Uehara D, Suzuki Y, Hatanaka T, Kudo T, Ishihara H, Sato K, Kakizaki S, Takagi H. β-Hydroxy-β-methyl Butyrate/L-Arginine/L-Glutamine Supplementation for Preventing Hand-Foot Skin Reaction in Sorafenib for Advanced Hepatocellular Carcinoma. In Vivo 2019; 33:155-161. [PMID: 30587616 DOI: 10.21873/invivo.11452] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 10/06/2018] [Accepted: 10/12/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND/AIM Sorafenib is standard treatment for advanced hepatocellular carcinoma (HCC). Hand-foot skin reaction (HFSR) is a notorious side-effect of this therapy. This study evaluated prophylactic benefits of an oral nutritional supplement (ONS) on sorafenib-associated HFSR in advanced HCC. PATIENTS AND METHODS This was a prospective, single-center, open-label trial arm using combined ONS and sorafenib in patients with unresectable HCC from August 2014 to February 2018. Control patients received sorafenib without ONS from 2011 to 2014. From September 2014, prophylactic ONS containing β-hydroxy-β-methylbutyrate (HMB), L-arginine, and L-glutamine was given. Sorafenib dosage was 400 mg/day for both groups. RESULTS Each group comprised 22 men and three women. Age, sex, Child-Pugh score, and clinical stage excluding IV-B did not significantly differ between the groups. HFSR occurred after 2 weeks: 15/25 patients in the control group (60%; HFSR grade 1: 6, grade 2: 7, grade 3: 2) vs. 8/25 in the ONS group (32%; HFSR grade 1: 4, grade 2: 4, grade 3: 0; p=0.047, Pearson's Chi-square test). CONCLUSION Prophylactic HMB, L-arginine and L-glutamine supplementation effectively prevented sorafenib-associated HFSR in patients with advanced HCC.
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Affiliation(s)
- Atsushi Naganuma
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan .,Nutrition Support Team, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan
| | - Takashi Hoshino
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan
| | - Nozomi Ohno
- Nursing Department, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan
| | - Yusuke Ogawa
- Nutrition Support Team, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan
| | - Tatsuma Murakami
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan
| | - Suguru Horiguchi
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan
| | - Daisuke Uehara
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan.,Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yuhei Suzuki
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan.,Department of Gastroenterology, Maebashi Red Cross Hospital, Maebashi, Japan
| | - Takeshi Hatanaka
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan.,Department of Gastroenterology, Gunma ken Saiseikai Maebashi Hospital, Maebashi, Japan
| | - Tomohiro Kudo
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan.,Nutrition Support Team, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan
| | - Hiroshi Ishihara
- Department of Gastroenterology, Takasaki General Medical Center, National Hospital Organization, Takasaki, Japan
| | - Ken Sato
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Satoru Kakizaki
- Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hitoshi Takagi
- Department of Gastroenterology, Kusunoki Hospital, Fujioka, Japan
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