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Gobbo M, Joy J, Guedes H, Shazib MA, Anderson C, Abdalla-Aslan R, Peechatanan K, Lajolo C, Nasir KS, Gueiros LA, Nagarajan N, Hafezi Motlagh K, Kandwal A, Rupe C, Xu Y, Ehrenpreis ED, Tonkaboni A, Epstein JB, Bossi P, Wardill HR, Graff SL. Emerging pharmacotherapy trends in preventing and managing oral mucositis induced by chemoradiotherapy and targeted agents. Expert Opin Pharmacother 2024; 25:727-742. [PMID: 38808634 DOI: 10.1080/14656566.2024.2354451] [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: 02/19/2024] [Accepted: 05/08/2024] [Indexed: 05/30/2024]
Abstract
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.
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Affiliation(s)
- Margherita Gobbo
- Unit of Oral and Maxillofacial Surgery, Ca' Foncello Hospital, Piazzale Ospedale, Treviso, Italy
| | - Jamie Joy
- Department of Pharmacy, Fred Hutchinson Cancer Center, Seattle, WA, USA
| | - Helena Guedes
- Medical Oncology Department, Centro Hospitalar Vila Nova de Gaia/Espinho, Porto, Portugal
| | - Muhammad Ali Shazib
- Workman School of Dental Medicine, High Point University, High Point, NC, USA
| | - Carryn Anderson
- Department of Radiation Oncology, University of Iowa Hospitals & Clinics, Iowa City, USA
| | - Ragda Abdalla-Aslan
- Department of Oral and Maxillofacial Surgery, Rambam Health Care Campus, Haifa, Israel
- Ruth and Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Khunthong Peechatanan
- Supportive and Palliative Care Unit, Monash Health, Clayton, VIC, Australia
- Department of Medicine, Division of Medical Oncology, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Carlo Lajolo
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS, School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Khawaja Shehryar Nasir
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Luiz Alcino Gueiros
- Department of Clinic and Preventive Dentistry & Oral Medicine Unit, Health Sciences Center, Hospital das Clínicas, Federal University of Pernambuco, Recife, Brazil
| | - Nivethitha Nagarajan
- Department of Orofacial Sciences, School of Dentistry, University of California San Francisco, California, USA
| | - Kimia Hafezi Motlagh
- Department of Oral Medicine, School of Dentistry, Tehran University of Medical Sciences, Tehran, Iran
| | - Abhishek Kandwal
- Himalayan Institute of Medical Sciences Cancer Research Institute Swami Rama Himalayan University, Uttarakhand, India
| | - Cosimo Rupe
- Head and Neck Department, Fondazione Policlinico Universitario A. Gemelli-IRCCS, School of Dentistry, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Yuanming Xu
- Department of Diagnostic Sciences, Tufts University School of Dental Medicine, Boston, MA, USA
| | - Eli D Ehrenpreis
- Department of Medicine, Advocate Lutheran General Hospital, Park Ridge, IL, USA
- E2Bio Life Sciences, Skokie, IL, USA
| | - Arghavan Tonkaboni
- Oral Medicine Department, School of Dentistry, Tehran University of Medical Science, Tehran, Iran
| | - Joel B Epstein
- Department of Surgery, City of Hope National Cancer Center, Duarte, CA, USA
| | - Paolo Bossi
- Medical Oncology and Hematology Unit, IRCCS Humanitas Research Hospital, Rozzano (Milan), Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Hannah R Wardill
- School of Biomedicine, The University of Adelaide, Adelaide, Australia
- Supportive Oncology Research Group, Precision Cancer Medicine Theme, South Australian Health and Medical Research Institute, Adelaide, Australia
| | - Stephanie L Graff
- Lifespan Cancer Institute, Providence, RI, USA
- Legorreta Cancer Center, Brown University, Providence, RI, USA
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Hata H, Takada S, Sato J, Yoshikawa K, Imamachi K, Edo M, Sagawa T, Fujikawa K, Ueda M, Matsuzaka M, Kitagawa Y. Analgesic effects of indomethacin spray on drug-induced oral mucositis pain in patients with cancer: A single-arm cross-sectional study. SPECIAL CARE IN DENTISTRY 2021; 41:498-504. [PMID: 33735535 PMCID: PMC8360043 DOI: 10.1111/scd.12587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/02/2021] [Accepted: 03/04/2021] [Indexed: 11/30/2022]
Abstract
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 (PR3days) 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 PR3days 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.
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Affiliation(s)
- Hironobu Hata
- Department of Dentistry and Oral Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Shinya Takada
- Department of Pharmacy, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Jun Sato
- Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Kazuhito Yoshikawa
- Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
| | - Kenji Imamachi
- Department of Dentistry and Oral Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Minako Edo
- Department of Dentistry and Oral Surgery, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Tamotsu Sagawa
- Department of Gastroenterology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Koshi Fujikawa
- Department of Gastroenterology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Michihiro Ueda
- Department of Clinical Oral Oncology, National Hospital Organization Hokkaido Cancer Center, Sapporo, Japan
| | - Masashi Matsuzaka
- Clinical Research Support Centre, Hirosaki University Hospital, Hirosaki, Japan.,Department of Medical Informatics, Hirosaki University Hospital, Hirosaki, Japan
| | - Yoshimasa Kitagawa
- Oral Diagnosis and Medicine, Faculty of Dental Medicine, Hokkaido University, Sapporo, Japan
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