The role of benzydamine in prevention and treatment of chemoradiotherapy-induced mucositis

Abstract

Purpose To discuss the role of benzydamine in the prevention and treatment of radiation-induced oral mucositis (OM) in head and neck (H&N) cancer patients. This document represents an expert opinion paper on indications and key-role aspects in OM pathogenesis, prevention and treatment. Oral mucositis OM represents a common side effect of chemotherapy (CHT) and radiotherapy (RT). It consists in a painful erythema involving the oral cavity mucosa, which may progress to ulceration. Five biologically dynamic phases are considered crucial in mucositis: “initiation, signalling, amplification, ulceration and healing”. Oral environment and microbiota are fundamental in mucositis development being involved in susceptibility to infections and in ulceration consequences. Different agents against mucositis have been studied and the use of benzydamine is strongly supported in literature. The Multinational Association of Supportive Care in Cancer and International Society for Oral Oncology (MASCC/ISOO) guidelines recommend its use for the prevention of OM in H&N patients undergoing RT and RT/CHT. Benzydamine Benzydamine is a local anti-inflammatory drug with analgesic properties. It can decrease TNF-α, IL-1β and prostaglandin synthesis, also inhibiting leukocyte-endothelial interactions, neutrophil degranulation, vasodilation and vascular permeability. Literature agrees on the beneficial effects of benzydamine in preventing and reducing oral mucositis severity in H&N cancer patients undergoing RT/CHT. Conclusions Mucositis represents a major concern in H&N cancer patients and a clinical and economical issue. A multimodal and multidisciplinary approach is needed for its management. International guidelines recommend benzydamine for OM prevention and treatment in H&N cancer patients, but further “real world” trials should be designed.

Low level laser therapy versus benzydamin in prevention and treatment of oral mucositis induced by anticancer treatments (clinical and biochemical study)

“…Understanding the involvement of cytokines in the etiology of RIOM may aid in the development of management methods. The proinflammatory cytokines TNFα and IL-6 have been examined and done in multiple studies, all of which have shown an elevation in TNF-a and IL-6 levels [18][19][20].…”

Association of MTHFR and ABCB1 polymorphisms with MTX‐induced mucositis in Chinese paediatric patients with acute lymphoblastic leukaemia, lymphoma or osteosarcoma—A retrospective cohort study

“…3,[21][22][23] A variety of methods have been tried for the prevention or treatment of mucositis, including ice chips, glutamine and N-acetylcysteine, benzydamine hydrochloride, benzydamine hydrochloride, luteolin, peptides, and prostaglandin E1and E2, but none has proven benefits in patients receiving prolonged infusions of HDMTX. 3,9,10,24,25 Some authors declared that Palifermin, a recombinant human keratinocyte growth factor that stimulates growth of epithelial cells, could reduce the incidence of mucositis, but no agreement has been reached on the standardized interventions till now. 3,9 When mucositis occurred, clinicians in our hospital choose to modify the dosing of leucovorin to minimize the side effects, but there is a lag behind adverse reactions, the ongoing cellular damage can cause secondary infection and result in longer stays of hospitalization.…”

“…5,6 Diverse methods have been tried to prevent or treat mucositis, but no good intervention has proven beneficial in patients receiving continuous infusions of HDMTX. [7][8][9][10][11] Due to the immature immune systems, children are more susceptible to bacteria, viruses or other microbe infections than the adults. 12 Identification of the risk factors involving adverse drug reactions can contribute to the individualization of HDMTX, and to improving therapeutic safety without compromising the anticancer effect.…”

Casein Microgels as Benzydamine Hydrochloride Carriers for Prolonged Release

“…Benzydamine hydrochloride (Benz) is a well-known non-steroidal anti-inflammatory drug with an antimicrobial effect, along with analgesic and anesthetic ones [24]. It can be applied both locally and systemically, but it influences mostly oral conditions such as ulcers [24], mucositis [25], and postoperative sore throat [26].…”