Emerging pharmacotherapy trends in preventing and managing oral mucositis induced by chemoradiotherapy and targeted agents

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.
Khunthong Peechatanan, Supportive and Palliative Care Unit, Monash Health, Clayton, VIC, Australia.
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, Advocate Health - MidwestFollow
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.
Hannah R. Wardill, School of Biomedicine, The University of Adelaide, Adelaide, Australia.
Stephanie L. Graff, Lifespan Cancer Institute, Providence, RI, USA.

Affiliations

Advocate Lutheran General Hospital

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.

Type

Article

PubMed ID

38808634

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