Analgesic effects of indomethacin spray on drug-induced oral mucositis pain in patients with cancer: A single-arm cross-sectional study

Emerging pharmacotherapy trends in preventing and managing oral mucositis induced by chemoradiotherapy and targeted agents

INTRODUCTION

The introduction of targeted therapy and immunotherapy has tremendously changed the clinical outcomes and prognosis of cancer patients. Despite innovative pharmacological therapies and improved radiotherapy (RT) techniques, patients continue to suffer from side effects, of which oral mucositis (OM) is still the most impactful, especially for quality of life.

AREAS COVERED

We provide an overview of current advances in cancer pharmacotherapy and RT, in relation to their potential to cause OM, and of the less explored and more recent literature reports related to the best management of OM. We have analyzed natural/antioxidant agents, probiotics, mucosal protectants and healing coadjuvants, pharmacotherapies, immunomodulatory and anticancer agents, photobiomodulation and the impact of technology.

EXPERT OPINION

The discovery of more precise pathophysiologic mechanisms of CT and RT-induced OM has outlined that OM has a multifactorial origin, including direct effects, oxidative damage, upregulation of immunologic factors, and effects on oral flora. A persistent upregulated immune response, associated with factors related to patients' characteristics, may contribute to more severe and long-lasting OM. The goal is strategies to conjugate individual patient, disease, and therapy-related factors to guide OM prevention or treatment. Despite further high-quality research is warranted, the issue of prevention is paramount in future strategies.

Analgesic effects of indomethacin spray on drug-induced oral mucositis pain in patients with cancer: A single-arm cross-sectional study

Aims

Symptomatic treatment is insufficient for chemotherapy‐ or targeted therapy‐induced oral mucositis (OM) pain, and benzydamine mouthwash is not commercially available in Japan. We evaluated the analgesic effects of an in‐hospital preparation of 0.25% indomethacin spray (IMS) on anticancer drug‐induced OM pain.

Methods

This single‐arm prospective trial enrolled 20 patients (median age 62.0 years) with OM and numerical rating scale scores of ≥5 who were undergoing chemotherapy or targeted therapy in our hospital. Pain scores were recorded using a visual analog scale (VAS) before and 30 min after IMS administration. Pain relief (PR) scores were recorded at 15, 30, and 60 min after IMS administration; total PR after 60 min (TOTPAR₆₀) was calculated, and the mean PR score after 3 days (PR_3days) was determined.

Results

The median (interquartile range) OM grade of the participants was 2.0 (2.0–2.3). The VAS score decreased significantly at 30 min after IMS administration (p = .001). The median (interquartile range) TOTPAR₆₀ and PR_3days were 6.0 (3.8–7.3) and 2.0 (2.0–3.0), respectively.

Conclusions

IMS helped improve patients’ quality of life. The risk of systemic adverse effects was low because of the low dose administered. IMS effectively relieved anticancer drug‐induced OM pain and may be useful for immediate self‐medication.