Oral Mucositis and Stomatitis Associated with Conventional and Targeted Anticancer Therapy

Abstract

Oral mucositis and stomatitis are characterized by pain, inflammation, and redness in the oral cavity. In the case of mucositis, ulceration also occurs. Despite being understudied, these symptoms are some of the most troubling, and yet common, adverse effects associated with cancer treatment. The incidence of these toxicities is highly variable depending on treatment-related and patient-related risk factors. However, most cancer treatment regimens carry some risk of this toxicity. The presence of mucositis or stomatitis can result in a significant decrease in the patient's quality of life due to severe pain and the inability to eat or drink. These toxicities can also negatively affect the overall outcome of cancer treatment, leading to dose reductions and delays in treatment. Although the mechanism is not yet understood, the rapid increase in the number of targeted anticancer therapies available on the market has increased the number of patients who experience oral toxicities. The toxicities caused by targeted agents are less severe than those caused by conventional anticancer agents, but due to prolonged dosing schedules, they can still lead to significant declines in quality of life. The pathobiology of oral mucositis is a complex five phase process. It involves injury, activation of enzymes and transcription factors, upregulation of cytokine genes, inflammation/damage to tissue, and healing. These processes not only involve cells in the oral mucosa, but also the surrounding fibroblasts and connective tissue cells. A better understanding of the mechanisms behind oral mucositis and stomatitis will facilitate the development of effective prediction, prevention, and treatment strategies.

Pigmentation of the tongue with lapatinib treatment in a patient with advanced breast cancer: A case report

“…11,12 The use of targeted therapies for HER-1 and HER-2, as well as other cellular targeted agents are growing rapidly. 13 For many of these targeted therapies, the adverse effect profiles continue to emerge. These toxicities, especially dermatologic toxicities, seem to be associated with improved response to therapy.…”

“…It can be challenging to identify the toxicities of targeted agents because they can combine with or accentuate toxicities from conventional therapies. 13 For this reason, toxicities from targeted agents may be underreported.…”

Evaluation of Modulatory Effect of Combination of Spondias Pinnata and Whey Preparation on Intestinal Antioxidants and Inflammatory Markers in Etoposide Induced Rat Model for Mucositis

“…The samples were centrifuged at 3000g for 10 min .To 2ml of this supernatant, 0.67%of Thiobarbituric acid (TBA) was added and kept in boiling water bath for 10 min and cooled. The pink chromogen that was developed was read immediately at 532nm.TBARS concentration was calculated using molar extinction co-efficient of chromophore (1.56×10 5 (mol/l)…”

“…4 Chemotherapy causing inflammation and ulceration of mucous membrane lining the digestive tract, which results in reduced food intake and drop in the pH levels and may cause treatment reduction or withdrawal. 5 Intestine being an important organ required for absorption of nutrients, due to the side effects the patients likely to suffer from loss of appetite and may also have deficiencies of vitamins, minerals etc. Thus, innovative and integrated nutritional approaches are needed to target several of these altered processes.…”

Effects of a Rebamipide Mouthwash on Stomatitis Caused by Cancer Chemotherapy<br/>&mdash;Evaluation of the Efficacy by Patients Themselves&mdash;

“…Secondary infections are associated with decreased immune competence due to higher rates of mouth infections, undernutrition, and myelosuppression. 2) In addition, stomatitis involves both distress and pain, as well as anorexia, sleep disturbance, mental distress, and other serious medical conditions. This may further decrease the quality of life and have a serious impact on the continuation of cancer chemotherapy.…”