Chemotherapy-Induced Oral Mucositis

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.

Growth factors and cytokines in the prevention and treatment of oral and gastrointestinal mucositis

“…KGF is secreted in vivo by mesenchymal cells. It has been suggested to play an important role in mesenchymalepithelial communication, stimulating proliferation of epithelial cells [43,68]. Due to its effect on epithelial cells, KGF has been proposed as an intervention for mucositis to stimulate regeneration, differentiation and growth of epithelial cells [19].…”

“…Members of the TGF-β (β1, β2, β3) family may inhibit proliferation of many cell types, such as epithelial and endothelial cells and lymphoid and haematopoietic cells, and cause growth arrest and apoptosis [33]. TGF-β3 is an inhibitor of cell division of epithelial cells, arresting cells in the G1 phase, and may thus have a potential to reduce mucositis [43].…”

Methotrexate and oral ulceration

“…Such mucositis is difficult to manage and causes much distress in affected patients. 6 Oral ulceration in the low dose methotrexate treatment regimes of rheumatoid arthritis is less common. The risk of a high dosage occurring accidentally however, is increased by the unusual dosage regime.…”

Integration of Reaction Kinetics Theory and Gene Expression Programming to Infer Reaction Mechanism

“…Oral cavity mucositis is a condition observed in cancer patients receiving radiation therapy or chemotherapy. It is characterized by inflammation followed by sepsis and bacterial infection in the oral cavity (Knox et al 2000, Niscola et al 2007, Peterson 1999, Sonis 2004. The result of this condition is significant pain, interruption of therapy, increased costs due to hospitalization, and in some cases death , Peterson et al 2007).…”