Top

Drugs & Aging

Published in:

01-10-2000 | Disease Management

Chemotherapy-Induced Oral Mucositis

Prevention and Management

Authors: Dr Jennifer J. Knox, Anitasha L. V. Puodziunas, Ronald Feld

Published in: Drugs & Aging | Issue 4/2000

Abstract

Oral mucositis is a frequent and potentially severe complication of chemotherapy which has a considerable impact on patient quality of life. While the management of other chemotherapy-related toxicities has improved, the incidence of mucositis is increasing. A critical review of the literature published between 1985 and 1999 reveals very few strategies or agents with proven efficacy, leaving few recommendations for the standard care in the prevention and treatment of mucositis at this time. Recommendations that can be made include: reducing patient risk factors, implementing proven preventative interventions such as utilising oral ice chips with fluorouracil chemotherapy, and optimising supportive care practices individualised to the patients’ needs and symptoms. Progress in understanding the pathophysiology of mucositis at the molecular level has led to the evaluation of a number of new investigational agents, specifically those directed to the epithelial mucosa, such as mitogens and epithelial growth factors. These appear to be very promising in preclinical studies. Randomised clinical trials with these agents may finally demonstrate an impact on the clinical practice of mucositis management in the coming years.

Rubenstein EB. Evaluating cost-effectiveness in outpatient management of medical complications in cancer patients. Curr Opin Oncol 1998; 10: 297–301PubMedCrossRef

Sonis ST, Sonis AL, Liekerman A. Oral complications in patients receiving treatment for malignancies other than the head and neck. J Am Dent Assoc 1979; 97: 468–72

Mahood DJ, Dose AM, Loprinzi CL, et al. Inhibition of fluoro-uracil-induced stomatitis by oral cryotherapy. J Clin Oncol 1991; 9: 449–52PubMed

Loprinzi CL, Dose AM. Studies on the prevention of 5-fluorouracil-induced oral mucositis. NCI Monogr 1990; 9: 93–4PubMed

Woo SB, Sonis ST, Monopoli MM, et al. A longitudinal study of oral ulcerative mucositis in bone marrow transplant recipients. Cancer 1993; 72: 1612–7PubMedCrossRef

Dodd MJ, Facione NC, Dibble SH, et al. Comparison of methods to determine the prevalence and nature of oral mucositis. Cancer Pract 1996; 4(6): 312–8PubMed

McCarthy GM, Awde JD, Gtardi H, et al. Risk factors associated with mucositis in cancer patients receiving 5-FU. Oral Oncol 1998; 34: 484–90PubMedCrossRef

Sonis ST. Mucositis as a biological process: a new hypothesis for the development of chemotherapy-induced stomatotoxicity. Oral Oncol 1998; 34: 39–43PubMedCrossRef

Sonis S, Tracey C, Shklar G, et al. An animal model for mucositis induced by cancer chemotherapy. Oral Surg Oral Med Oral Pathol 1990; 69: 437–43PubMedCrossRef

10.

Porta C, Moroni M, Nastasi G. Allopurinol mouthwashes in the treatment of 5-fluorouracil-induced stomatitis. Am J Clin Oncol 1994; 17: 246–7PubMedCrossRef

11.

Loprinzi CL, Cianflone SG, Dose AM, et al. A controlled evaluation of an allopurinol mouthwash as prophylaxis against 5-florouracil-induced stomatitis. Cancer 1990; 65: 1879–82PubMedCrossRef

12.

Levi F, Zidani R, Missel JL. Randomized multicentre trial of chronotherapy with oxaliplatin, fluorouracil, and folinic acid in metastatic colorectal cancer. Lancet 1997; 350: 681–6PubMedCrossRef

13.

Cascinu S, Fedeli A, Fedeli SL, et al. Oral cooling (cryotherapy), an effective treatment for the prevention of 5-fluorouracil-induced stomatitis. Eur J Cancer B Oral Oncol 1994; 30B: 234–6PubMedCrossRef

14.

Sato A, Kumagai S, Sakaki K, et al. Inhibition of 5-fluorouracil-cisplatin-induced stomatitis by oral cryotherapy: use of an ice-bar containing fibrinolysin and deoxyribonuclease combine (Elase) [in Japanese]. Gan To Kagaku Ryoho 1997; 24: 1135–9PubMed

15.

Rocke LK, Loprinzi CL, Lee JK, et al. A randomized clinical trial of two different durations of oral cryotherapy for prevention of 5-fluorouracil related stomatitis. Cancer 1993; 72: 2234–8PubMedCrossRef

16.

Wolfrom C, Hartmann R, Fengler R, et al. Randomized comparison of 36-hour intermediate-dose versus 4-hour high-dose methotrexate infusions for remission induction in relapsed childhood acute lymphoblastic leukemia. J Clin Oncol 1993; 11:827–33PubMed

17.

Ahmed T, Engelking C, Szalyga J, et al. Propantheline prevention of mucositis from etoposide. Bone Marrow Transplant 1993; 12: 131–2PubMed

18.

Ackland SP, Schilsky RL. High-dose methotrexate: a critical re-appraisal. J Clin Oncol 1987; 5: 2017–31PubMed

19.

Oliff A, Bleyer WA, Poplock DG. Methotrexate-induced oral mucositis and salivary methotrexate concentrations. Cancer Chemother Pharmacol 1979; 2: 225–5PubMedCrossRef

20.

Mills ED. The modifying effect of beta-carotene on radiation and chemotherapy-induced oral mucositis. Br J Cancer 1988; 57: 416–7PubMedCrossRef

21.

Labar B, Mrsic M, Pavletic Z, et al. Prostaglandin E₂ for prophylaxis of oral mucositis following BMT. Bone Marrow Transplant 1993; 11: 379–82PubMed

22.

Pettengell R, Gurney H, Radford JA, et al. Granulocyte colony-stimulating factor to prevent dose-limiting neutropenia in non-Hodgkin’s lymphoma: a randomized controlled trial. Blood 1992; 80: 1430–6PubMed

23.

Katano M, Nakamura M, Matsuo T, et al. Effect of granulocyte colony-stimulating factor (G-CSF) on chemotherapy-induced oral mucositis. Surg Today 1995; 25: 202–6PubMedCrossRef

24.

Karthaus M, Rosenthal C, Huebner G, et al. Effect of topical oral G-CSF on oral mucositis: a randomized placebo-controlled trial. Bone Marrow Transplant 1998; 22: 781–5PubMedCrossRef

25.

Chi KH, Chen CH, Chan WK, et al. Effect of granulocyte-mac-rophage colony-stimulating factor on oral mucositis in head and neck cancer patients after cisplatin, fluorouracil, and leucovorin chemotherapy. J Clin Oncol 1995; 13: 2620–8PubMed

26.

Nemunaitis J, Rosenfeld CS, Ash R, et al. Phase III randomized, double-blind placebo-controlled trial of rhGM-CSF following allogeneic bone marrow transplantation. Bone Marrow Transplant 1995; 15: 949–54PubMed

27.

Jebb SA, Osborne RJ, Maughan TS, et al. 5-Flourouracil and folinic acid-induced mucositis: no effect of oral glutamine supplementation. Br J Cancer 1994; 70: 732–5PubMedCrossRef

28.

Duenas-Gonzalez A, Sobrevilla-Calvo P, Frias-Medivil M, et al. Misoprostol prophylaxis for high-dose chemotherapy-induced mucositis: a randomized double-blind study. Bone Marrow Transplant 1996; 17: 809–12PubMed

29.

Cohen G, Elad S, Or R, et al. The use of tretinoin as oral mucositis prophylaxis in bone marrow transplantation patients: a preliminary study. Oral Dis 1997; 3: 243–6PubMedCrossRef

30.

Weite K, Zadler C, Reiter A, et al. Differential effects of GMCSF in children with severe congenital neutropenia. Blood 1990; 75: 1056–63

31.

Wilkes JD. Prevention and treatment of oral mucositis following cancer chemotherapy. Semin Oncol 1998; 25(5): 538–51PubMed

32.

Dedhar S, Gabomy L, Gallaway P, et al. Human GM-CSF is a growth factor active on a variety of cell types of non-hemato-poietic origin. Proc Natl Acad Sci U S A 1988; 85: 9253–7PubMedCrossRef

33.

Zaghlonl MS, Dorce MJ, Kallman RF, et al. Interleukin-1 increases thymidine labelling index of normal tissue of mice but not the tumor. Int J Radiat Oncol Biol Phys 1994; 29: 805–11CrossRef

34.

Sonis S, Muska A, O’Brien J, et al. Alteration in the frequency, severity and duration of chemotherapy-induced mucosits in hamsters by interleukin-11. Eur J Cancer B Oral Oncol 1996; 31B: 261–6

35.

Sher CJ, Roberts JM. Inhibitors of mammalian Gl cyclin-dependent kinases. Genes Dev 1995; 9: 1149–63CrossRef

36.

Spijkervet F, Sonis S. New frontiers in the management of chemotherapy-induced mucositis. Curr Opin Oncol 1998; 10Suppl. 1:523–7

37.

Werner S. Keratinocyte growth factor: a unique player in epithelial repair processes. Cytokine Growth Factor Rev 1998; 9(2): 153–65PubMedCrossRef

38.

Danilenko D. Pre-clinical and early clinical development of keratinocyte growth-factor. Toxicol Pathol 1999; 27(1): 64–71PubMedCrossRef

39.

Ferretti GA, Ash RC, Brown AT, et al. Control of oral mucositis and candidiasis in marrow transplantation: a prospective, double-blind trial of chlorhexidine digluconate oral rinse. Bone Marrow Transplant 1988; 3: 483–93PubMed

40.

Ferretti GA, Raybould TP, Brown AT, et al. Chlorhexidine prophylaxis for chemotherapy and radiotherapy-induced stomatitis: a randomized double-blind trial. Oral Surg Oral Med Oral Pathol 1990; 69: 331–8PubMedCrossRef

41.

Rutkauskas JS, Davis JW. Effects of chlorhexidine during im-munosuppressive chemotherapy: a prelimininary report. Oral Surg Oral Med Oral Pathol 1993; 76: 441–8PubMedCrossRef

42.

Bubley GJ, Chapman B, Chapman SK, et al. Effect of acyclovir on radiation and chemotherapy-induced mouth lesions. Anti-microb Agents Chemother 1989; 33: 862–5CrossRef

43.

Bergmann OJ, Mogensen SC, Ellermann-Eriksen S, et al. Acyclovir prophylaxis and fever during remission-induction therapy of patients with acute mycloid leukemia: a randomized, double-blind, placebo-controlled trial. J Clin Oncol 1997; 15: 2269–74PubMed

44.

Prada A, Chiesa F. Effects of benzydamine on the oral mucositis during antineoplastic radiotherapy and/or intra-arterial chemotherapy. Int J Tissue React 1987; 9: 115–9PubMed

45.

Fidler P, Loprinzi CL, O’Fallon JR, et al. Prospective evaluation of a chamomile mouthwash for prevention of 5-FU-induced oral mucositis. Cancer 1996; 77: 522–5PubMedCrossRef

46.

Weisdorf DJ, Bostrom B, Raether D, et al. Oropharyngeal mucositis complicating bone marrow transplantation: prognostic factors and the effect of chlorhexidine mouth rinse. Bone Marrow Transplant 1989; 4: 89–95PubMed

47.

Wahlin BY. Effects of chlorhexidine mouthrinse on oral heal in patients with acute leukemia. Oral Surg Oral Med Oral Pathol 1989; 68: 279–87PubMedCrossRef

48.

Dodd MJ, Larson PJ, Dibble SL, et al. Randomized clinical trial of chlorhexidine versus placebo for prevention of oral mucositis in patients receiving chemotherapy. Oncol Nurs Forum 1996; 23: 921–7PubMed

49.

Borowski B, Benhamou E, Pico JL, et al. Prevention of oral mucositis in patients treated with high-dose chemotherapy and bone marrow transplantation: a randomized controlled trial comparing two protocols of dental care. Eur J Cancer B Oral Oncol 1994; 30B: 93–7PubMedCrossRef

50.

Clift RA, Bianco JA, Appelbaum FR, et al. A randomized controlled trial of pentoxifylline for the prevention of regimenrelated toxicities in patients undergoing allogeneic marrow transplantation. Blood 1993; 82: 2025–30PubMed

51.

Attal M, Huguet F, Rubie H, et al. Prevention of regimen-related toxicities after bone marrow transplantation by pentoxifylline: a prospective, randomized trial. Blood 1993; 82: 732–6PubMed

52.

Verdi CJ, Garewal HS, Koenig LM, et al. A double-blind, randomized, placebo-controlled, crossover trial of pentoxifylline for the prevention of chemotherapy-induced oral mucositis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995; 80: 36–42PubMedCrossRef

53.

Rahn R, Adamietz IA, Bõttcher FfD, et al. Povidone-iodine to prevent mucositis in patients during antineoplastic radio-chemotherapy. Dermatology 1997; 195Suppl. 2: 57–61PubMedCrossRef

54.

Pfeiffer P, Madsen EL, Hansen O, et al. Effect of prophylactic sucralfate suspension on stomatitis induced by cancer chemotherapy: a randomized, double-blind cross-over study. Acta Oncol; 29: 171–3

55.

Shenep JL, Kalwinsky DK, Hutson PR, et al. Efficacy of ora sucralfate suspention in prevention and treatment of chemotherapy-induced mucositis. J Pediatr 1988; 113: 758–63PubMedCrossRef

56.

Loprinzi CL, Ghosh C, Camoriano J, et al. Phase III controlled evaluation of sucralfate to alleviate stomatitis in patients receiving fluorouracil-based chemotherapy. J Clin Oncol 1997; 15: 1235–8PubMed

57.

Malik IA, Moid I, Haq S, et al. A double-blind, placebo-controlled, randomized trial to evaluate the role of tetrachlor-odecaoxide in the management of chemotherapy-induced oral mucosits. J Pain Symptom Manage 1997; 14(2): 82–7PubMedCrossRef

58.

Wadleigh RG, Redman RS, Graham ML, et al. Vitamin E in the treatment of chemotherapy-induced mucositis. Am J Med 1992; 92: 481–4PubMedCrossRef

59.

Lopez I, Goudou C, Ribrag V, et al. Treatment of mucositis with vitamine E prior to administration of myelosuppressive chemotherapy [in French]. Ann Med Interne Paris 1994; 52: 489–92

60.

Feld R. The role of surveillance cultures in patients likely to develop chemotherapy-induced mucositis. Support Care Cancer 1997; 5: 371–5PubMedCrossRef

61.

Abdelaal AS, Barker DS, Fergusson MM. Treatment for irradiation-induced mucositis [letter]. Lancet 1989; I: 97CrossRef

62.

Beck S. The impact of a systematic oral care protocol on stomatitis after chemotherap. Cancer Nurs 1979; 2: 185–99PubMedCrossRef

63.

Bondi E, Baroni C, Prete A, et al. Local antimicrobial therapy of oral mucositis in pediatric patients undergoing bone marrow transplantation. Oral Oncol 1997; 33: 322–6PubMedCrossRef

64.

Loprinzi CL, Gastineau DA, Foote RL. Oral complications. In: Abeloff MD, Armitage JO, Allen SL, et al., editors. Clinical oncology. New York (NY): Churchill Livingstone, 2000: 965–97

Title: Chemotherapy-Induced Oral Mucositis
Prevention and Management
Authors: Dr Jennifer J. Knox
Anitasha L. V. Puodziunas
Ronald Feld
Publication date: 01-10-2000
Publisher: Springer International Publishing
Published in: Drugs & Aging / Issue 4/2000
Print ISSN: 1170-229X
Electronic ISSN: 1179-1969
DOI: https://doi.org/10.2165/00002512-200017040-00002

Live Webinar | 27-06-2024 | 18:00 (CEST)

Keynote webinar | Spotlight on medication adherence

Reserve your place

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

WHO estimates that half of all patients worldwide are non-adherent to their prescribed medication. The consequences of poor adherence can be catastrophic, on both the individual and population level.

Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.

Prof. Kevin Dolgin

Prof. Florian Limbourg

Prof. Anoop Chauhan

Developed by: Springer Medicine

Obesity Clinical Trial Summary

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.

Developed by: Springer Medicine

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 4/2000

Preventing Fractures in Postmenopausal Women with Osteoporosis

Conceptualisation and Measurement of Frailty in Elderly People

Peritoneal Dialysis

Angiogenesis Inhibitors

Optimising Therapy for Insulin-Treated Type 2 Diabetes Mellitus

Aging-Related Changes in Skeletal Muscle

Keynote webinar | Spotlight on medication adherence

Live: Thursday 27th June 2024, 18:00-19:30 (CEST)

At a glance: The STEP trials