Interventions for preventing oral mucositis for patients with cancer receiving treatment

Worthington, Helen V; Clarkson, Jan E; Eden, Tim

doi:10.1002/14651858.cd000978.pub3

Cited by 170 publications

(242 citation statements)

References 208 publications

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“…A similar conclusion has been reached by the Cochrane review in this area (39) . The problem has been that the majority of the studies performed have been small and have poor reporting of methodology.…”

Section: Discussionsupporting

confidence: 85%

Symposium 4: Hot topics in parenteral nutrition A review of the use of glutamine supplementation in the nutritional support of patients undergoing bone-marrow transplantation and traditional cancer therapy

Crowther

2009

Proc. Nutr. Soc.

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The relationship between glutamine and malignancy can be traced back to the 1950s and the requirement for glutamine for malignant-cell growth in culture. Later studies demonstrated an association between the rate of proliferation of the malignant cells and glutamine usage. The excessive use of glutamine by malignant cells was seen as an opportunity for the development of a treatment using glutamine analogues, but unfortunately excessive toxicity was observed during clinical studies. In animal models glutamine supplementation, initially thought to increase tumour growth, actually causes tumour regression as a result of improved immune clearance of the tumour and appears to reduce the severity of the side effects of chemo- and radiotherapy. This finding led to human studies in both traditional cancer therapy and bone-marrow transplantation, which are reviewed here. Unfortunately, the majority of the studies performed are small and have poor methodological reporting. There is clinical heterogeneity in terms of routes of administration, dosing schedules, chemotherapy regimens and diseases. Studies of glutamine in non-bone-marrow transplantation chemo- and/or radiotherapy treatment suggest a possible trend towards reductions in objective mucositis but no effect on subjective symptoms. There is no evidence for its effect on other clinical outcomes. For bone-marrow transplantation there appears to be some benefit from oral glutamine in reducing mucositis and graft v. host disease, while intravenous glutamine may reduce infections but at the expense of an increased relapse rate. Good-quality studies are required in this area.

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Section: Discussionsupporting

confidence: 85%

Symposium 4: Hot topics in parenteral nutrition A review of the use of glutamine supplementation in the nutritional support of patients undergoing bone-marrow transplantation and traditional cancer therapy

Crowther

2009

Proc. Nutr. Soc.

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“…The meta-analysis performed by Worthington, and coworkers found a statistically significant benefit for palifermin to reduce the incidence of oral mucositis [43]. The meta-analysis included all available studies but did not discriminate between different clinical settings.…”

Section: Resultsmentioning

confidence: 99%

Systematic review of cytokines and growth factors for the management of oral mucositis in cancer patients

Raber-Durlacher

Bültzingslöwen²,

Logan

et al. 2012

Support Care Cancer

113

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Purpose The aim of this project was to review the literature and define clinical practice guidelines for the use of cytokines and growth factor agents for the prevention or treatment of oral mucositis induced by cancer chemotherapy or radiotherapy. Care Cancer (2013) 21:343-355 DOI 10.1007/s00520-012-1594 following three guideline determinations was possible: Recommendation, Suggestion, No guideline possible. Results Sixty-four clinical studies across 11 interventions were evaluated. A recommendation was made for the use of recombinant human KGF-1 (palifermin) at a dose of 60 μg/kg per day for 3 days prior to conditioning treatment and for 3 days post-transplant for prevention of oral mucositis in patients receiving high-dose chemotherapy and total body irradiation followed by autologous stem cell transplantation for hematological malignancies. A suggestion was made against using granulocyte macrophage colony-stimulating factor mouthwash for the prevention of oral mucositis in the setting of high-dose chemotherapy followed by autologous or allogeneic stem cell transplantation. No guideline was possible for any other cytokine or growth factor agents due to inconclusive evidence. Conclusions Of the cytokine and growth factor agents studied for oral mucositis, the evidence only supports use of palifermin in the specific population listed above. Additional welldesigned research is needed on other cytokine and growth factor interventions and in other cancer treatment settings. Methods

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“…Sucralfate has also been shown to be effective in reducing the severity of mucositis but other interventions such as aloe vera, amifostine, intravenous glutamine, G-CSF, honey, laser and antibiotic lozenges containing polymixin/ tobramycin/amphotericin (PTA) have shown weaker evidence of benefit. 28 Antioxidant agents possess some benefits in the prevention of OM. Amifostine, an antioxidant and cytoprotective agent, has been evaluated in several studies for prevention and treatment of OM but there is little evidence to show that amifostine may prevent OM.…”

Section: Discussionmentioning

confidence: 99%

“…Amifostine, an antioxidant and cytoprotective agent, has been evaluated in several studies for prevention and treatment of OM but there is little evidence to show that amifostine may prevent OM. 23,28,29 Moreover, one of the main concerns about amifostine administration is the possibility of several adverse reactions including nausea, vomiting and hypotension. 30 Zinc is another antioxidant, which was reported to prevent the occurrence of OM in patients with head and neck cancer who were undergoing radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

N-acetyl cysteine for prevention of oral mucositis in hematopoietic SCT: a double-blind, randomized, placebo-controlled trial

Moslehi

Taghizadeh-Ghehi

Gholami

et al. 2014

Bone Marrow Transplant

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Oral mucositis (OM) is a complication of high-dose chemotherapy (HDC) which is frequently observed in hematopoietic SCT settings. Antioxidant agents have been proposed to prevent OM and therefore N-acetyl cysteine (NAC) could have an important role. In the present study, we conducted a double-blind, randomized, placebo-controlled study to evaluate the NAC effect on OM incidence and severity, and also glutathione peroxidase-1 activity. Leukemia patients undergoing allogeneic hematopoietic SCT preceded by HDC were recruited into the study and received either NAC (100 mg/kg/day) (n = 38) or placebo (n = 42) from the starting day of HDC until day +15 after transplantation. OM was evaluated daily for 21 days after transplantation according to World Health Organization oral toxicity scale. The incidence of severe OM (grades 3-4) was significantly lower in the NAC group (23.7% vs 45.3%, P = 0.04). Moreover, the mean duration of OM was significantly shorter in the intervention group (6.24(2.96) vs 8.12(3.97) days, P = 0.02). The glutathione peroxidase-1 activity was also significantly higher in the NAC group seven days after transplantation (3.38(2.19) vs 2.41(1.70) ng/mL, P = 0.003). It is concluded that parenteral NAC is effective in reducing the incidence of severe cases and the total duration of OM.

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Interventions for preventing oral mucositis for patients with cancer receiving treatment

Abstract: Publication status and date: New search for studies and content updated (conclusions changed), published in Issue 12, 2010. Review content assessed as up-to-date: 7 November 2010.

Cited by 170 publications

References 208 publications

Symposium 4: Hot topics in parenteral nutrition A review of the use of glutamine supplementation in the nutritional support of patients undergoing bone-marrow transplantation and traditional cancer therapy

Symposium 4: Hot topics in parenteral nutrition A review of the use of glutamine supplementation in the nutritional support of patients undergoing bone-marrow transplantation and traditional cancer therapy

Systematic review of cytokines and growth factors for the management of oral mucositis in cancer patients

N-acetyl cysteine for prevention of oral mucositis in hematopoietic SCT: a double-blind, randomized, placebo-controlled trial

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