Systematic review of agents for the management of cancer treatment-related gastrointestinal mucositis and clinical practice guidelines

Abstract

The aim of this study was to update the clinical practice guidelines for the use of agents for the prevention and/or treatment of gastrointestinal mucositis (GIM). Methods A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: Recommendation, Suggestion, and No Guideline Possible. Results A total of 78 papers across 13 interventions were examined of which 25 were included in the final review. No new guidelines were possible for any agent due to inadequate and/or conflicting evidence. Existing guidelines for probiotics and hyperbaric oxygen were unchanged. Conclusions Of the agents studied for the prevention and treatment of GIM, the evidence continues to support use of probiotics containing Lactobacillus spp. for prevention of chemoradiotherapy and radiotherapy-induced diarrhea in patients with pelvic malignancy, and hyperbaric oxygen therapy to treat radiation-induced proctitis. Additional well-designed research is encouraged to enable a decision regarding palifermin, glutamine, sodium butyrate, and dietary interventions, for the prevention or treatment of GIM.

MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy

“…For more detailed results, including lists of all reviewed articles, please refer to the published article for each section. [11][12][13][14][15][16][17][18] Guidelines that are new or were changed compared with the 2014 guidelines are discussed below and appear in Table 1. Guidelines for which there was new evidence but the statements remained unchanged appear in Table 1 only.…”

“…These differences have been clarified in the detailed articles. [11][12][13][14][15][16][17][18]27 Furthermore, some of the interventions may only be available in certain geographic areas (eg, certain herbal compounds) or may have different regulations determined by local drug agencies (eg, PBM). Economic challenges also may play a role in the selection of the preferred treatment.…”

Probiotic Propionibacterium freudenreichii requires SlpB protein to mitigate mucositis induced by chemotherapy

“…In this context, some studies have proposed the use of probiotic bacterial strains, as promising candidates in the treatment or prevention of inflammatory conditions such as mucositis [14,19]. Clinical studies indicate a positive effect of selected lactobacilli in patients with mucositis [20,21], while nothing is known about the effect of probiotic propionibacteria. Accordingly, the MASCC/ISOO (Association of Supportive Care in Cancer/International Society of Oral Oncology) clinical practice guidelines for the management of mucositis secondary to cancer therapy [22] recently added new guidelines, including one suggestion for probiotic agents containing Lactobacillus species for the prevention of chemotherapy and radiationinduced diarrhea in patients with pelvic malignancy as an adjuvant treatment.…”

Glutamin in der Ernährungstherapie – Welche Indikation bleibt?

“…Angesichts der unsicheren Datenlage sprechen sich die deutschen Leitlinien gegen den Einsatz von Glutamin zur Prophylaxe sowohl der radiogenen als auch der medikamentös induzierten Diarrhö aus [7]. Internationale Konsensuspapiere fordern weitere Studien [108].…”