Prophylaxis Of Oral Mucositis Research Articles

Palifermin Compared to Supersaturated Calcium Phosphate Rinse in Prevention of Severe Oral Mucositis after Stem Cell Transplantation in Patients Receiving Radiotherapy-Based Myeloablative Conditioning

Purpose: Oral mucositis (OM) is a common, debilitating complication of conditioning regimens for hematopoietic stem cell transplantation (HSCT). Supersaturated calcium phosphate rinse (SCPR) and palifermin have shown efficacy in preventing severe OM. However, whether their efficacy differs is unknown. We aimed to compare the efficacy of SCPR and palifermin in HSCT patients receiving myeloablative conditioning. Methods: A comprehensive review of our institutional database was performed to identify patients who received myeloablative-conditioning therapy over 5 years. All HSCT patients who received radiotherapy-based myeloablative conditioning and received either palifermin or SCPR within the study period were included. Most patients received Fludarabine, Busulfan, and total body irradiation (FBT). Patients were divided into two groups based on the OM prophylactic agent received. The primary outcome is prevalence of severe OM (WHO Grade 3 and 4). The secondary outcomes are a prevalence of all-grade OM and WHO Grade 4 OM. These outcomes were compared between the two groups. Results: We identified 26 patients who received SCPR and 122 patients who received palifermin for OM prophylaxis. The prevalence of World Health Organization (WHO) Grade 3 or 4 OM was significantly lower in the palifermin group (57% vs. 100%, p = 0.01). In addition, the palifermin group had lower WHO Grade 4 OM (22% vs. 62%, p = 0.0006). The overall prevalence of OM was not significantly different between the two groups (86% for palifermin group vs. 100% for SCPR arm, p = 0.15). Subgroup analyses demonstrated improved outcomes with palifermin, regardless of age, sex, disease status, donor type, and primary diagnosis. Conclusion: When compared to SCPR, the use of palifermin is associated reduced severity of OM in HSCT patients receiving radiotherapy-based myeloablative conditioning.

Use of Honey in the Management of Chemotherapy-Associated Oral Mucositis in Paediatric Patients.

BackgroundOral mucositis (OM) is a critical condition during chemotherapy in both adult and child cancer patients. Paediatric cancer patients have a higher prevalence of OM than adult cancer patients. Honey is a natural product that has been reported to have the best tissue healing properties. The present mini-review focused on the evaluation of the effectiveness of oral care with honey products in the treatment and prophylaxis of chemotherapy-induced OM in child patients.MethodsA network of electronic English databases including CINAHL, CENTRAL, EMBASE, MEDLINE and PubMed, were used for primary search from April 2010 to April 2020. We have also considered data collected from ClinicalTrials.gov, Web of Science and Google Scholar. PRISMA software was used to build collective data. Controlled trials were included in this review and were critically appraised by Down and Black. The narrative synthesis was performed.ResultsA total number of 346 data of children and adolescents with cancer were considered in this short review. All patients were from three randomized controlled trial articles and two were non-randomised controlled trial articles. Based on the evidence so far revealed, honey may show an effect in the treatment and prophylaxis of OM. The analysis of collected data revealed that the probability value P<0.05. The honey enhanced recovery time and severity of OM were significantly compared with those without honey treatment receiving group of pediatric patients.ConclusionHoney not only has been shown to have the capability for healing injured tissues but it is also a more economical treatment, and it has fewer side effects compared to synthetic drugs. Honey or honey products can prevent chemotherapy-induced OM (CIOM) and be the best treatment to grade I, II and III CIOM. However, it is disappointing that studies involving children as patients were few, and limited data available so far.

Impact of systemic dexamethasone administration on oral mucositis induced by anthracycline-containing regimens in breast cancer treatment

Oral mucositis (OM) is one of the most common complications associated with chemotherapy. Here, we evaluated whether systemic dexamethasone (DEX) dosage in prophylactic antiemetics affected the incidence of OM in anthracycline-containing regimens. Patients receiving anthracycline-containing regimens for breast cancer were divided into high- and low-DEX dose groups and retrospectively evaluated. The incidence of all-grade OM in the first cycle in the high- and low-dose groups was 27.3% and 53.5%, respectively, and was significantly lowered by increasing the DEX dose (P < 0.01); thus, the study met its primary endpoint. The result in all treatment cycles was also significant (P = 0.02). In contrast, the incidence of dysgeusia was similar between the high- and low-dose groups in the first and all cycles (13.6% and 16.3% in the first cycle [P = 0.79] and 27.3% and 34.9% in all cycles [P = 0.42], respectively). Multivariate analysis revealed that low DEX dosage was an independent risk factor for all-grade OM development. In conclusion, our study suggests that DEX attenuates OM in anthracycline-containing regimens for breast cancer treatment in a dose-dependent manner. Further evaluation of OM prophylaxis, including DEX administration, is required for better control.

Phase II Trial of Vosaroxin and Infusional Cytarabine for Frontline Treatment of Acute Myeloid Leukemia (VITAL) Patients Eligible for Intensive Chemotherapy: A Planned Interim Analysis

Phase II Trial of Vosaroxin and Infusional Cytarabine for Frontline Treatment of Acute Myeloid Leukemia (VITAL) Patients Eligible for Intensive Chemotherapy: A Planned Interim Analysis

Oral mucositis - problem nadal aktualny w medycynie i stomatologii

Oral mucositis (OM) caused by ionizing radiation is a significant therapeutic problem concerning almost all patients with head and neck cancers undergoing irradiation, however, an effective treatment method is still missing. Therapeutic ac­tions concentrate mostly on prophylaxis, including the maintenance of the correct hygiene of the oral cavity. In 2014 the International Society of Oral Oncology (ISOO) together with the (Multinational Association of Supportive Care in Cancer (MASCC) worked out the guidelines for the treatment of patients with z OM induced by radiotherapy and chemotherapy. In 2019 these guidelines were updated. Research is ongoing to find medication which could be applicable for the prevention and treatment of OM. The problem is grave as it might complicate the progress of oncological treatment, deteriorate the patient’s quality of life or even affect the prognosis. This paper describes the pathogenesis of oral mucositis, the current trends in treatment and discusses the role of a dentistry doctors in the care of the patient with symptoms of this condition. The article also refers to the role of a multidisciplinary team – the OM prophylaxis – as part of the preparation of an oncological patient for irradiation.

Efficacy of keratinocyte growth factor in prevention of oral mucositis in children undergoing allogeneic hematopoietic cell transplantation

AbstractIntroductionOral mucositis is regarded by patients as one of the worst and debilitating complications of conditioning and hematopoietic cell transplantation (HCT). Prevention of mucositis is one of the priorities of supportive therapy during and after conditioning.ObjectivesThe primary objective of the study was the analysis of efficacy of keratinocyte growth factor (KGF, palifermin) used in prophylaxis of oral mucositis in patients undergoing allo-HCT. The secondary objectives of the study included the analysis of the influence of palifermin on clinical course of oral mucositis and early transplant outcomes, as well as analysis of the contraindications of palifermin in patients undergoing allo-HCT.Patients and methodsA total number of 253 allo-HCT performed between 2003 and 2018 in patients aged 0–19 years in a single center were analyzed. Overall, in 161 HCTs, palifermin was administered.ResultsPatients receiving KGF were transplanted earlier in the context of calendar year, and more often received ATG, mainly due to the higher rate of unrelated donor transplants. Allo-HCT patients who were administered palifermin had shorter time of mucositis (median: 9 vs. 13 days, p &lt; 0.001), lower mucositis grade (median: 2° vs. 3°; p &lt; 0.001), shorter period of total parenteral nutrition (median: 19 vs. 22 days; p = 0.018), and lower incidence of episodes of febrile neutropenia (median: 39.1% vs. 83.1%; p &lt; 0.001).ConclusionsThe use of palifermin has decreased duration and severity of oral mucositis in children after allo-HCT. Palifermin is a safe and well-tolerated compound in children undergoing allo-HCT.

The efficacy of Polyvynilpyrrolidone-Zn Gluconate and Taurine in the Prevention of Oral Mucositis in Haematological Patients

Oral mucositis (OM) is a significant problem in patients undergoing standard or high-dose chemotherapy and/or radiotherapy for the management of haematological disorders, associated with patient morbidity and increased resource use. The OM management relies on supportive care and symptom palliation. This study evaluates the results of Polyvynilpyrrolidone-Zn gluconate and taurine (GelX� Oral Spray) in this setting. This is an observational, retrospective study, conducted on 145 paediatric and adult patients. All patients received GelX� Oral Spray as prophylaxis for OM. The research was supported by BMG Pharma S.p.A. The prevention of OM in patients treated with GelX� Oral Spray was reached in 54 patients (37.24%), 22 adults (22.22%) and 32 children (69.56%). A total number of 52 patients (35.86%) developed severe OM when GelX� was used as preventive treatment, 40 adults (40.4%) adults and 12 children (26.08%). Grade 4 OM developed in 16 patients (11.03%), 10 adults and 1 child (68.75%) had a complete remission of OM, while 3 adults and 2 children (31.25%) had partial remission. No patient had to interrupt chemo/radiotherapy due to OM. GelX� Oral Spray was considered safe, no adverse device effect or severe adverse device effect were considered related to the use of the product. This retrospective study supports prophylactic use of GelX� Oral Spray to minimize the risk of OM secondary to chemo/radiotherapy.

The VITAL Trial: Phase II Trial of Vosaroxin and Infusional Cytarabine for Frontline Treatment of acute Myeloid Leukemia

The VITAL Trial: Phase II Trial of Vosaroxin and Infusional Cytarabine for Frontline Treatment of acute Myeloid Leukemia

A brief literature review and own clinical experience in prophylaxis of oral mucositis in children using low level laser therapy

Objective: The article describes the experience of clinical application of low level laser therapy in pediatric oncology for the prevention and treatment of chemotherapy complications such as oral mucositis.Background: For this purpose, for the first time in the world non-invasive laser blood illumination is used on the sinocarotid zone (on the projection of the common carotid artery symmetrically) and popliteal fossa in order to stimulate the phagocytic activity of leukocytes.Methods: 25 children with different oncological diseases were given non-invasive laser blood illumination treatment (904 nm, pulse mode, 100 ns, 50-150 Hz, 5-7 W, 4 cm2, 1-2 minutes daily per each procedure) 1-3 days before the beginning of chemotherapy. For the objectification of the results of treatment, the phagocytic activity of leukocytes was evaluated.Results: None of the children who underwent low level laser therapy course had any complications and no cases of oral mucositis developed.Conclusions: Clinical experience has shown high efficacy and safety of low level laser therapy aimed at preventing the development of complications of chemotherapy, primarily oral mucositis, and stimulating the phagocytic activity of leukocytes.

Patient and oncologist perceptions regarding symptoms and impact on quality-of-life of oral mucositis in cancer treatment: results from the Awareness Drives Oral Mucositis PercepTion (ADOPT) study.

This descriptive cross-sectional survey aims to assess the level of concordance between the perspectives of oncologists and those of patients regarding oral mucositis (OM) symptoms, and the impact of OM on various aspects of daily living and concurrent cancer management. Oncologists involved in OM management (n = 105), and patients who developed OM during cancer treatment (n = 175), were recruited from seven Asian countries. Oncologists completed a face-to-face, quantitative interview; patients completed a face-to-face interview, and a self-reported questionnaire. Oncologists and patients ranked treatment-induced OM among the three most important toxicities of cancer therapy requiring intervention. The most frequent OM symptoms reported by patients were oral ulcers (74%), dry mouth (73%), and difficulty swallowing (62%). Oncologists expected mild OM symptoms to last slightly longer than 1week, whereas patients reported mild symptoms for more than 2weeks. In mild-to-moderate OM, oncologists underestimated patients' pain experience. Overall, only 45% of oncologists said they would initiate OM prophylaxis when cancer therapy started. Of the 87% of patients who said they used their prescribed medications, only 16% reported using prophylactically prescribed medication. While oncologists' concerns related to the delays and interruptions of cancer treatment, patients tended to focus on the effects of OM on eating, drinking, and talking. Oncologists' and patients' perceptions about treatment-induced OM differ. To overcome discordant perspectives, there is a need to raise general awareness and improve proactive management of OM. As noted in recent guidelines, supportive cancer care is critical for ensuring optimal therapy and for improving the patient's experience.

Efficacy of oral cryotherapy on oral mucositis prevention in patients with hematological malignancies undergoing hematopoietic stem cell transplantation: a meta-analysis of randomized controlled trials.

ObjectivesControversy exists regarding whether oral cryotherapy can prevent oral mucositis (OM) in patients with hematological malignancies undergoing hematopoietic stem cell transplantation (HSCT). The aim of the present meta-analysis was to evaluate the efficacy of oral cryotherapy for OM prevention in patients with hematological malignancies undergoing HSCT.MethodsPubMed and the Cochrane Library were searched through October 2014. Randomized controlled trials (RCTs) comparing the effect of oral cryotherapy with no treatment or with other interventions for OM in patients undergoing HSCT were included. The primary outcomes were the incidence, severity, and duration of OM. The secondary outcomes included length of analgesic use, total parenteral nutrition (TPN) use, and length of hospital stay.ResultsSeven RCTs involving eight articles analyzing 458 patients were included. Oral cryotherapy significantly decreased the incidence of severe OM (RR = 0.52, 95% CI = 0.27 to 0.99) and OM severity (SMD = -2.07, 95% CI = -3.90 to -0.25). In addition, the duration of TPN use and the length of hospitalization were markedly reduced (SMD = -0.56, 95% CI = -0.92 to -0.19; SMD = -0.44, 95% CI = -0.76 to -0.13; respectively). However, the pooled results were uncertain for the duration of OM and analgesic use (SMD = -0.13, 95% CI = -0.41 to 0.15; SMD = -1.15, 95% CI = -2.57 to 0.27; respectively).ConclusionsOral cryotherapy is a readily applicable and cost-effective prophylaxis for OM in patients undergoing HSCT.

Management of oral mucositis in patients with head and neck cancer receiving chemoradiotherapy and/or molecular targeted therapy

To investigate the prevalence and treatment of oral mucositis caused by concurrent chemoradiotherapy and/or molecular targeted therapy in the patients with advanced squamous cell carcinoma of the head and neck. A retrospective study of the incidence and treatment of oral mucositis was performed in 179 patients (155 male and 24 female;124 patients at stage III and 55 patients at stage IV) receiving concurrent chemotherapy and (or) molecular targeted therapy between November 2007 and November 2010. Grade I, II, III and IV oral mucositis occurred respectively in 49, 50, 67 and 13 patients. All the patients received oral mucositis prophylaxis. After the occurrence of oral mucositis, conventional treatment of mucositis combined with quinolone antibiotics were applied. Of the patients, 99 patients with grade I or II and 4 patients with grade III oral mucositis were effectively managed by conventional treatment; 76 patients with grade III or IV oral mucositis were also significantly controled by conventional treatment plus antibiotics. After the treatments, all patients with oral mucositis were under control, with the decrease in the grade of oral mucositis, the reduction of oral pain and the improvement in ability to eat. None of them had radiation treatment breaks. Combined modality therapy can effectively control chemoradiation-induced oral mucositis in patients with head and neck squamous cell carcinoma, grade I and II oral mucositis were cured by conventional treatment and quinolone antibiotics play a key role in the treatments for grade III and IV oral mucositis.

Evaluation of Current and Upcoming Therapies in Oral Mucositis Prevention

Cancer chemotherapy has evolved from a few therapeutic agents in three drug classes to more than 50 drugs in over ten drug classes. With generally cytotoxic mechanisms of action, there is continued research interest in preventing and managing adverse events of chemotherapy. Although treatment-induced symptom management has made significant progress, most therapies lead to intolerable reactions that result in a dose reduction or discontinuation of therapy. Mucositis is a common adverse event that can occur after administration of systemic chemotherapy and/or radiation therapy leading to inflammatory lesions anywhere from the oral cavity to the GI tract. Although pathophysiologically similar, gastrointestinal mucositis and oral mucositis (OM) differ in terms of symptom presentation and offending therapies. The focus of the article will be on OM; gastrointestinal mucositis will be mentioned when therapy efficacy is relevant to OM. OM prophylaxis has been a subject of interest for at least the past 30 years, yet progress has been limited due to a lack of understanding of the condition. With the recent introduction of palifermin (Kepivance™), novel therapies continue to be developed that may significantly reduce the incidence, duration and/or severity of OM. In addition, outcomes including an improvement in patient quality of life, increasing treatment dose intensity or reducing healthcare costs may result from successful management of OM prophylaxis. This article will review currently available OM prophylactic therapies. Agents in preclinical or clinical development and natural supplements will also be discussed.

Efficacy, Safety and Tolerability of Biotene Mouthwash Versus Aloe Vera Juice and Active Manuka Honey for Prophylaxis of Oral Mucositis Following Chemoradiotheray

Background: Oral mucositis (OM) is a common and debilitating complication following high dose Methotrexate (MTX) as well as conditioning regimen for hematopoietic stem cell transplantation (HSCT). The mucosal injury varies in severity, ranging from mild inflammation to full thickness mucosal ulceration extending into submucosal layer. In the setting of damaged mucosal layer and neutropenia, secondary infection may happen which can lead to systemic sepsis. The vicious cycle of inflammation and secondary sepsis will trigger greater release of cytokines, such as tumor necrosis factor alpha and interleukin 1 beta that further worsen the mucosal insult. Patients who develop OM not only suffer from pain and poor quality of life but also infections which can be life-threatening. Obviously, OM causes increased duration of hospital stay, use of parenteral narcotics and nutrition support with increased treatment costs. Currently, there are no definitive approved methods/agents except Palifermin (Keratinocyte growth factor, KGF) that can prevent and/or reduce the severity, incidence and duration of OM. However, the use of Palifermin in our centre is constrained by its cost. Therefore, we explored the feasibility of locally available cheaper agents such as Biotene mouthwash, and the Aloe Vera juice and active Manuka Honey.Biotene mouthwash is alcohol free and contains antibacterial enzymes that reduce bacterial growth, oral irritation and promote gingival health. Aloe barbodensis inner leaf juice and honey is claimed to contain nutrients, minerals and vitamins.Patients and Methods: A total of 76 patients were enrolled between September 2007 and February 2008. Application of Biotene mouthwash was done every 6 hourly whereas Aloe Vera juice was consumed twice a day. All HSCT patients received oral Ciprofloxacin, Acyclovir and Fluconazole until Day +21 as prophylaxis. Patients receiving high dose MTX were hyperhydrated with urinary alkalinization. The degree of mucositis was assessed daily by nurses using the WHO grading of mucositis. Physicians were allowed to prescribe intravenous narcotics, analgesics and TPN and ICU care as required. Patients were requested to filll a self reported OM daily questionnaire based on usual analogue scale.Results: A total of 46 patients received Biotene mouthwash and 30 patients received Aloe Vera juice.29/46 (63%) vs. 13/30 (43.3%) received high dose MTX in the Biotene arm and Aloe Vera juice arm, respectively, whereas 17/46 (37%) vs. 17/30 (56.7%) received HSCT.The prevalence of grade 0, 1–2, 3–4 mucositis in patients received Biotene mouth wash and Aloe Vera juice are 17.4%, 52.2%, 30.4% and 26.7%, 56.7%, 16.7% respectively (Chi Square for trend, p = 0.145).Requirement for intravenous opioid was 0/46(0%) vs. 4/30(13.3), and TPN requirement was 0/46(0%) vs. 2/30(6.7).None of the patients required ICU management.Conclusions: Biotene mouthwash is similar to Aloe Vera juice in reducing/preventing the severity of mucositis in patient underwent MTX or conditioning regimen for HSCT. Both are safe and well tolerated. The can be considered as useful local measures in the prophylaxis of OM following chemoradiotheray.

The comparative effects of povidone-iodine and normal saline mouthwashes on oral mucositis in patients after high-dose chemotherapy and APBSCT—results of a randomized multicentre study

Antimicrobial solutions are widely used in the nursing care of chemotherapy induced oral mucositis (OM). There is little evidence, however, supporting their use for reducing mucosal damage. In our study, 132 patients were randomized to use normal saline (n=65) or povidone-iodine diluted 1:100 (n=67) mouthwashes for OM prophylaxis and treatment after high-dose chemotherapy comprising BEAM or HD-L-PAM followed by autologous peripheral stem cell transplantation. The study groups were well balanced in respect of age, sex, chemotherapy and the number of CD34+ cells in the graft. No significant difference was found between the groups in respect of OM characteristics, fever of unknown origin (FUO) and other infections. The antimicrobial solution was less tolerable for patients. OM occurred significantly more often in females than in males (86% vs 60%, P=0.0016) and was worse and of longer duration. The mechanical effect of mouthwashes might have a certain importance in FUO prevention. When indicating oral rinses, the patient's individual preference and tolerance of solutions offered should be considered.

Prophylaxis of oral mucositis in irradiated head-and-neck cancer patients: a proposed classification scheme of interventions and meta-analysis of randomized controlled trials

Purpose: To identify, classify, and evaluate agents used in the prophylaxis of oral mucositis in irradiated head and neck cancer patients. Methods: Data sources included multiple databases and manual citation review of relevant literature. Based on the eligibility criteria, 59 studies were independently reviewed by two reviewers. Forty-two studies were included in the classification scheme, of which 15 met the criteria for inclusion in the meta-analysis. Data were extracted by duplicate independent review, with disagreement resolved by consensus. Results: Overall, the interventions reduced the odds of developing severe oral mucositis, when assessed by clinicians, by 36% (OR: 0.64; 95% CI: 0.46, 0.88). Subgroup analysis suggested that only the narrow-spectrum antibacterial lozenges were effective (OR: 0.45; 95% CI: 0.23, 0.86); however, the power of the aggregated data in the other classes may have been insufficient to detect differences. When the outcome was assessed by patients, no significant difference was seen in the outcome between the treatment and the control groups (OR: 0.79; 95% CI: 0.56–1.12). Conclusions: Overall, interventions chosen on a sound biologic basis to prevent severe oral mucositis are effective. In particular, when oral mucositis is assessed by clinicians, narrow-spectrum antibiotic lozenges appear to be beneficial. Methodologic limitations were evident in many of the studies. Further research using validated measurement tools in larger, methodologically sound trials is warranted.

The therapeutic management of radiogenic oral mucositis

Acute reactions of oral mucosa are a frequent side effect of radiotherapy, which often necessitates interruption of the treatment. Marked proliferation of tumor stem cells during treatment interruptions may occur in squamous cell carcinomata, which represent the majority of tumors in the head and neck area. Hence a fatal consequence of treatment breaks may be a significant decrease in tumor cure rates. Furthermore, marked acute responses frequently result in increased late sequelae ("consequential damage"). Therefore, amelioration of the mucosal response aiming at avoiding treatment breaks and at reduction of late reactions could definitely increase the therapeutic success of radiation treatment. Various possibilities for the therapeutic management of radiation-induced oral mucositis with a symptomatic or radio- and epithelial biological background are summarized and presented systematically. A variety of prophylactic and therapeutic methods have been proposed for the management of acute radiation reactions of the oral mucosa. Frequently, their efficacy has been established for chemotherapy or in combination with other immunosuppressive treatments. Hence, systematical rather than local effects have to be considered. In general, prophylaxis of oral mucositis is mainly based on dental restoration or edentation, in combination with frequent oral hygienic measures after the meals and with antiseptic mouthwashes. Intensive personal care is recommended. The necessity of a percutaneous endoscopic gastrostoma is dependent on the status of the patient and on size and localization of the treatment area, i.e. the impairment of food uptake which is to be expected. Therapeutic intervention is restricted to local or systemic treatment of pain and local application of antimycotics and antibiotics.

387Evaluation of the efficacy and safety of GM-CSF in the prophylaxis of oral mucositis in patients with head & neck cancer treated with radiotherapy

387Evaluation of the efficacy and safety of GM-CSF in the prophylaxis of oral mucositis in patients with head & neck cancer treated with radiotherapy