Abstract
BackgroundChemotherapy-induced oral mucositis impairs the quality of life. The difference in severity of oral mucositis between different anti-epidermal growth factor receptor (EGFR) antibodies combined with cytotoxic drugs in colorectal cancer is unclear. The aim of this study was to investigate the differences in oral mucositis between panitumumab (Pmab) and cetuximab (Cmab) combined with 5-fluorouracil (5-FU).MethodsWe conducted a retrospective cohort study. A total of 75 colorectal cancer outpatients treated with an anti-EGFR antibody combined with FOLFOX, FOLFIRI, or 5-FU/leucovorin as the first- to third-line treatment were included. The primary endpoint was the incidence of grade 2–3 oral mucositis. The secondary endpoint was the time to onset of oral mucositis. We also compared the incidence of toxicities of interest, skin toxicity, hypomagnesaemia and neutropenia, and time to treatment failure (TTF) between the two groups.ResultsThirty-two patients treated with Pmab and 43 patients treated with Cmab were evaluated. Patient characteristics were similar between the two groups. The incidence of grade 2–3 oral mucositis was significantly higher with Pmab than with Cmab (31.3% vs 9.3%, P < 0.05). Moreover, the incidence of grade 3 oral mucositis was significantly higher in patients treated with Pmab (18.8% vs 0%, P < 0.01). The mean (SD) cycles to onset of the worst oral mucositis was 3.0 (2.9) in the Pmab group and 2.3 (1.7) in the Cmab group (P = 0.29). Oral mucositis was characterized by glossitis and cheilitis. The incidences of other toxicities were the following (Pmab vs Cmab): grade 2–3 skin toxicity: 68.8% vs 74.4% (P = 0.61), grade 2–3 hypomagnesaemia: 9.3% vs 7.0% (P = 1.00), grade 3–4 neutropenia: 28.1% vs 37.2% (P = 0.46). The median TTF was not significantly different, i.e., 223 days vs 200 days (P = 0.39) for Pmab vs Cmab.ConclusionsPmab-based chemotherapy resulted in significantly higher grades of oral mucositis compared with Cmab-based chemotherapy. The oral condition should be monitored carefully and early supportive care should be provided for patients treated with Pmab-based chemotherapy.
Highlights
Chemotherapy-induced oral mucositis impairs the quality of life
It was reported that the incidence of oral mucositis was 5 to 7% when an anti-epidermal growth factor receptor (EGFR) antibody was used as monotherapy [20]
Eligible patients were metastatic colorectal cancer outpatients treated with an anti-EGFR antibody combined with FOLFOX: infusional 5-FU plus leucovorin (5-FU/LV) with the addition of oxaliplatin, FOLFIRI: 5-FU/LV with the addition of irinotecan, or 5-FU/LV as the first- to third-line treatment at Kyoto-Katsura Hospital
Summary
The difference in severity of oral mucositis between different anti-epidermal growth factor receptor (EGFR) antibodies combined with cytotoxic drugs in colorectal cancer is unclear. Oral mucositis presents as erythema and/ or ulceration of the oral mucosa It is typically painful, requiring analgesics, leading to alteration in Epidermal growth factor (EGF) regulates epithelial cell proliferation, growth, and migration, is present in biological fluids, including saliva, and plays an important role in maintaining the epithelial barrier and healing damaged mucosa [5]. Anti-epidermal growth factor receptor (EGFR) antibodies, panitumumab (Pmab) and cetuximab (Cmab), are widely used for patients with wild-type (WT) KRAS metastatic colorectal cancer [9,10,11]. The mechanism of oral mucositis induced by the anti-EGFR antibody concomitant with 5-FU was not clarified, anti-EGFR therapy may deteriorate 5-FU-induced oral mucositis by interfering with the wound healing process due to blockage of EGF
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