New Frontiers in the Pathobiology and Treatment of Cancer Regimen-Related Mucosal Injury

Abstract

Mucositis is a common complication of chemotherapy, radiotherapy and targeted agents. It often affects compliance to anticancer therapies as it frequently causes schedule delays, interruptions or discontinuations of treatment. Moreover, the economic impact related to the management of mucositis is topical and several estimations of additional hospital costs due to this clinical condition have been recently reported. The ability to determine risk factors for mucositis, to early detect its onset, to assess correctly the degree of this toxicity and to plan its multidisciplinary management are all key elements to guarantee the quality of life of patients and to avoid useless dose reduction or interruption of treatment. The pathogenesis of mucositis is multifactorial and it is classily subdivided into oral and gastrointestinal mucositis according to its anatomic presentation. Treatment and patients’ related factors might help in predicting the frequency and the potential degree of symptoms onset. Here we discuss about clinical presentation and pathogenesis of mucositis in relation to different kinds of treatments. Moreover, we focus on therapeutic and prevention strategies, describing past and present management according to international guidelines and the most promising new data about agents potentially able to further improve the treatment of mucositis in the next future.

Upregulated epithelial junction expression represents a novel parameter of the epithelial radiation response to fractionated irradiation in oral mucosa

“…Hence, molecular changes leading to the development of a normal tissue response are of significant interest. Key mediators identified during the development of side effects can offer new targets for a biologically optimized treatment strategy [27–29]. …”

Luteolin prevents irinotecan‐induced intestinal mucositis in mice through antioxidant and anti‐inflammatory properties

“…Intestinal mucositis is a toxic manifestation resulting from many anti‐cancer treatments, including radiation or chemotherapy, and is characterized by extensive damage to the gut mucosa, leading to symptoms such as diarrhoea, bleeding, nausea, vomiting, abdominal pain, malnutrition, infections, and sepsis related to bacterial translocation (Vanhoecke et al, ). Reaching high incidence, 40% of patients receiving standard doses, and 100% of patients receiving high doses (Cinausero et al, ), the main consequence of this condition is failure of the chemotherapy. When this adverse effect occurs, it is generally necessary to decrease the dose or to interrupt the chemotherapeutic regime, decreasing the chances of cancer remission and increasing health care costs and death rates, either by cancer or by the complications resulting from intestinal damage (Ribeiro et al, ).…”

Alterations of colonic sensitivity and gastric dysmotility after acute cisplatin and granisetron

“…25 Among the 40% of the population experiencing visceral pain, 28% corresponds to cancer patients, in whom pain may be associated with metastasis or treatments. 26 In this context, visceral pain may be associated with the development of chemotherapy-induced mucositis 27 and enteric neuropathy, [28][29][30][31] frequent complications of these treatments. However, visceral pain was recently demonstrated to occur in the rat shortly after paclitaxel, another antineoplastic drug.…”