Randomized controlled and double-blinded study of Caphosol versus saline oral rinses in pediatric patients with cancer

BACKGROUND

Oral mucositis (OM) is a significant side effect of cancer treatment. The purpose of this study was to compare topically administered Caphosol to saline rinses in the prevention of mucositis in pediatric cancer patients.

PROCEDURE

A controlled, double-blinded, and randomized clinical crossover study recruited patients between 2 to 17.99 years of age who were diagnosed with a malignancy and were receiving either high-dose methotrexate (≥1 g/m² ), anthracycline, or cisplatin chemotherapy (NCT0280733). All patients received two 7-day cycles of the mouth rinses; that is, one cycle of Caphosol and one cycle of saline in a randomized order. Oral changes and symptoms were evaluated using the World Health Organisation (WHO) toxicity scale and the Children's International Mucositis Evaluation Scale (ChIMES). The primary endpoint was the frequency and severity of OM and oral symptoms.

RESULTS

A total of 56 patients were recruited to the study, of whom 45 were randomized with a median age of 6.5 years (range 2.1-17.1 years). No cases of severe OM were observed. Grade ≥ 3 oral symptoms were present at least once in six (13%) patients during the Caphosol cycle and 13 (29%) patients during the saline cycle (P = .12). The peak of symptom scores was evident at around day 4-7 after administration of the chemotherapy with no marked differences between the rinse solutions. Multivariable regression analysis did not indicate a benefit of using Caphosol over the saline solution.

CONCLUSIONS

No difference in prevention of oral mucositis was observed between the use of Caphosol or saline rinses.

Evaluation of efficacy of Caphosol in prevention and alleviation of acute side effects in patients treated with radiotherapy for head and neck cancers

AIM OF THE STUDY

Oral mucositis is a common side effect of the oral mucosa due to anticancer therapy, especially for head and neck cancer. Caphosol is indicated for dryness of the mouth and oropharynx and treatment of mucositis due to irradiation or high-dose chemotherapy. The aim of the study was to evaluate the efficacy of Caphosol in preventing and alleviating mucositis due to radiotherapy in the head and neck region.

MATERIAL AND METHODS

Caphosol was used from the beginning of the irradiation and for two weeks more after the treatment was completed. Mucositis, xerostomia, and dysphagia were scored by radiotherapists. Subjective evaluation was made by patients. Caphosol was assessed in a non-blinded, matched clinical study. Each treatment arm consisted of 50 patients. The groups were similar. The only difference in the management protocol between the treatment arms was the use of Caphosol in the experimental arm.

RESULTS

A statistically significant difference in mean severity of early irradiation-induced side effects between the studied groups was observed with respect to: mucositis in the clinical target volume (CTV) area, mucositis in the increased dose (boost) area, dysphagia and xerostomia (p < 0.001 for all reactions). In the group of patients who used Caphosol, the mucositis was less intense, both in the CTV and in the boost area.

CONCLUSIONS

The use of Caphosol reduces the severity of acute mucositis, dysphagia and xerostomia, exerting a positive effect on comfort in the oral cavity in patients irradiated for head and neck tumors.

A randomised controlled trial of Caphosol mouthwash in management of radiation-induced mucositis in head and neck cancer

PURPOSE

This phase III, non-blinded, parallel-group, randomised controlled study evaluated the efficacy of Caphosol mouthwash in the management of radiation-induced oral mucositis (OM) in patients with head and neck cancer (HNC) undergoing radical (chemo)radiotherapy.

PATIENTS AND METHODS

Eligible patients were randomised at 1:1 to Caphosol plus standard oral care (intervention) or standard oral care alone (control), stratified by radiotherapy technique and use of concomitant chemotherapy. Patients in the intervention arm used Caphosol for 7weeks: 6weeks during and 1-week post-radiotherapy. The primary endpoint was the incidence of severe OM (CTCAE ⩾grade 3) during and up to week 8 post-radiotherapy. Secondary endpoints include pharyngeal mucositis, dysphagia, pain and quality of life.

RESULTS

The intervention (n=108) and control (n=107) arms were well balanced in terms of patient demographics and treatment characteristics. Following exclusion of patients with missing data, 210 patients were available for analysis. The incidence of severe OM did not differ between the intervention and control arms (64.1% versus 65.4%, p=0.839). Similarly, no significant benefit was observed for other secondary endpoints. Overall, compliance with the recommended frequency of Caphosol was low.

CONCLUSION

Caphosol did not reduce the incidence or duration of severe OM during and after radiotherapy in HNC.

Phase II multicenter trial of Caphosol for the reduction of mucositis in patients receiving radiation therapy for head and neck cancer

PURPOSE

We conducted a phase II multicenter study evaluating Caphosol in patients receiving head and neck radiation (H/N RT) +/- chemotherapy or biologic sensitizer.

MATERIALS/METHODS

The primary endpoint of the study tested the rate of functional mucositis (WHO grade > or equal to 2) with the hypothesis that <75% of patients would develop > or equal to 2 mucositis with Caphosol compared with a historical rate of >90%. New methods were applied with higher than historic rigor. 5 Institutions were included in this study: Moffitt Cancer Center (MCC), MD Anderson Cancer Center (MDACC), Duke University Cancer Center (DUCC), University of Florida (UF) and Temple University Cancer Center (TUCC). Caphosol was taken by patients at least 4 times a day and up to 10 times per day commencing with day 1 of RT and for a total duration of 8 weeks after completion of RT. Detailed questionnaires were completed weekly by patients and a unique algorithm was used to generate the WHO grade of mucositis.

RESULTS

98 Patients were enrolled in the study. 59/98 (60%) patients were evaluable for the primary endpoint giving us 80% power. All evaluable patients experienced WHO grade > or equal to 2 mucositis and the trial failed to reject the null hypothesis. > or equal to 2 mucositis rates at weeks 2, 4, 6, 11 and 15 were as follows: 45%, 90%, 98%, 71%, 50%.

CONCLUSION

We were unable to demonstrate that Caphosol significantly reduced WHO grade 2 or higher mucositis below a 90% historic rate. We are not surprised with this finding given our rigorous methodology in grading.

Treatment of Active Mucositis With Caphosol (Calcium Phosphate): A Retrospective Case-Series

Background

Mucositis is a common side effect due to chemo and/radiation therapy. Caphosol has been a proven preventive strategy against mucositis in randomized clinical trials. However, its efficacy to treat active mucositis in patients treated for solid tumors with chemotherapy is unknown. The objective was to evaluate the efficacy of Caphosol to treat mucositis by comparing the grade of mucositis before and after treatment and documenting the duration of treatment.

Methods

A retrospective review was conducted on consecutive adult patients at London Regional Cancer Program (LRCP) who developed chemotherapy-induced oral mucositis and were then treated with Caphosol. This study was approved by ethics committee at University of Western Ontario.

Results

A total of 21 patients, two males (one with cancer esophagus and another with lung cancer) and 19 females (all with breast cancer), with a median age of 59 years were evaluated. Grade 3 mucositis was present in 4 patients who completely resolved with Caphosol in an average of 4 days of treatment, without needing any hospitalization. Fifteen patients with grade 2 mucositis reverted back to grade 0 by using Caphosol for an average of 3.5 days. One patient with no effect had grade 1 mucositis dating prior to treatment with chemotherapy and remained as such. Another patient with no initial improvement had oral candidiasis and once treated with Fluconozole and Caphosol had a complete resolution. No obvious side effects were reported by patients related to the use of Caphosol.

Conclusion

Our case series, for the first time, shows that Caphosol may be used as a potentially effective treatment in patients with solid tumor, who develop chemotherapy-induced mucositis.