Oral mucositis associated with anti-EGFR therapy in colorectal cancer: single institutional retrospective cohort study

Abstract

BackgroundChemotherapy-induced oral mucositis impairs the quality of life. The difference in severity of oral mucositis between different anti-epidermal growth factor receptor (EGFR) antibodies combined with cytotoxic drugs in colorectal cancer is unclear. The aim of this study was to investigate the differences in oral mucositis between panitumumab (Pmab) and cetuximab (Cmab) combined with 5-fluorouracil (5-FU).MethodsWe conducted a retrospective cohort study. A total of 75 colorectal cancer outpatients treated with an anti-EGFR antibody combined with FOLFOX, FOLFIRI, or 5-FU/leucovorin as the first- to third-line treatment were included. The primary endpoint was the incidence of grade 2–3 oral mucositis. The secondary endpoint was the time to onset of oral mucositis. We also compared the incidence of toxicities of interest, skin toxicity, hypomagnesaemia and neutropenia, and time to treatment failure (TTF) between the two groups.ResultsThirty-two patients treated with Pmab and 43 patients treated with Cmab were evaluated. Patient characteristics were similar between the two groups. The incidence of grade 2–3 oral mucositis was significantly higher with Pmab than with Cmab (31.3% vs 9.3%, P < 0.05). Moreover, the incidence of grade 3 oral mucositis was significantly higher in patients treated with Pmab (18.8% vs 0%, P < 0.01). The mean (SD) cycles to onset of the worst oral mucositis was 3.0 (2.9) in the Pmab group and 2.3 (1.7) in the Cmab group (P = 0.29). Oral mucositis was characterized by glossitis and cheilitis. The incidences of other toxicities were the following (Pmab vs Cmab): grade 2–3 skin toxicity: 68.8% vs 74.4% (P = 0.61), grade 2–3 hypomagnesaemia: 9.3% vs 7.0% (P = 1.00), grade 3–4 neutropenia: 28.1% vs 37.2% (P = 0.46). The median TTF was not significantly different, i.e., 223 days vs 200 days (P = 0.39) for Pmab vs Cmab.ConclusionsPmab-based chemotherapy resulted in significantly higher grades of oral mucositis compared with Cmab-based chemotherapy. The oral condition should be monitored carefully and early supportive care should be provided for patients treated with Pmab-based chemotherapy.Electronic supplementary materialThe online version of this article (10.1186/s12885-018-4862-z) contains supplementary material, which is available to authorized users.

Pembrolizumab-Induced Immune-Mediated Glossitis

“…Although skin and dermatological manifestations have been widely reported as adverse effects in the pharmacological profiles of PD-1 and PD-L1 inhibitors, adverse outcomes involving the oral mucosa have been rare and under-reported with these classes. A single institutional retrospective cohort study found a large incidence of oral mucositis as an adverse effect with the combination of anti-estimated glomerular filtration rate (EGFR) agents such as cetuximab and panitumumab with 5-fluorouracil (5-FU) in the treatment of colorectal cancer [ 3 ]. This study made further conclusions in panitumumab being a bigger culprit than cetuximab in inducing this adverse outcome.…”

Safety Assessment on Serious Adverse Events of Targeted Therapeutic Agents Prescribed for RAS Wild-Type Metastatic Colorectal Cancer: Systematic Review and Network Meta-Analysis

“…Mucositis is a common AE noticed in cancer patients on chemotherapy and is associated with poor quality of life [ 48 , 49 ]. Evidence suggests that the incidence of mucositis increases with concomitant administration with EGFR inhibitors such as cetuximab and panitumumab [ 50 ]. Moreover, consistent with our study results, a retrospective cohort study revealed a higher rate of mucositis in patients on panitumumab than those on cetuximab [ 50 ].…”

“…Evidence suggests that the incidence of mucositis increases with concomitant administration with EGFR inhibitors such as cetuximab and panitumumab [ 50 ]. Moreover, consistent with our study results, a retrospective cohort study revealed a higher rate of mucositis in patients on panitumumab than those on cetuximab [ 50 ]. Nonetheless, uncertainty remains about whether the risk of serious mucositis is higher with panitumumab than with cetuximab, but careful monitoring and management of mucositis are warranted especially in panitumumab-treated patients due to potential risks.…”

Risk factors for oral mucositis in patients with solid tumors under treatment with cetuximab: a retrospective cross-sectional study.

“…Still, the incidence increases signi cantly when chemotherapy is used concomitantly [26]. When used as monotherapy for colorectal cancer treatment, the incidence of oral mucositis does not exceed 10% of patients [27]. During treatment for skin cancer, this adverse effect is not even mentioned as signi cant [28,29].…”