1 Numerous molecularly targeted agents are associated with mucositis however, the risk is particularly pronounced with anti-angiogenic tyrosine kinase inhibitors (TKIs), such as sunitinib, sorafenib, axitinib, pazopanib, and cabozantinib. In the literature, targeted agent–induced mucositis is frequently referred to as stomatitis to distinguish it from the mucositis seen with chemotherapy or radiotherapy and to highlight the differences in the mechanism of injury. Newer molecularly targeted agents also carry the risk of mucositis. Healing: Healing occurs once there is cessation from ongoing tissue damage that initiated the mucositis. During this stage, there is a high risk for bacterial colonization and the development of sepsis. Ulceration: The result of cellular damage becomes clinically apparent lesions in the mucosa may be apparent. During this stage, mucositis may still be subclinical or only subtly present. Signal amplification: NF-κB activation ultimately results in the production of the inflammatory cytokines tumor necrosis factor-α, interleukin-1β (IL-1β), and IL-6, which lead to tissue damage and cell death. Primary damage response: Cellular damage activates p53 and nuclear factor-κB (NF-κB), which is likely the most significant event in propagating the damage response. The mucosa is grossly normal during this stage. Initiation: Radiation and/or chemotherapy induces cellular damage, which promotes reactive oxygen species formation within the basal epithelium and submucosal cells. 4 More recently, the Five-Stage Model of Oral Mucositis has been proposed 4: Historically, chemotherapy-induced mucositis has been conceptualized as a result of cytotoxic damage to rapidly dividing submucosal basal cells, resulting in epithelial cell damage, whereas radiation-induced mucositis results from damage to epithelial cells exposed to radiation. This review primarily covers the management of oral mucositis we do not specifically cover distal GI tract mucositis, graft-versus-host disease, mucositis as the result of hematopoietic stem-cell transplantation, or antimicrobial treatment of the infectious complications of mucositis. In this review, we discuss the pathophysiology of mucositis its assessment and the approach to its prevention and management with regard to the inciting agent-chemotherapy, radiotherapy, or molecularly targeted agents. 1- 3 Therefore, the prevention and management of therapy-related mucositis is a critical part of the oncologist’s job.Ī range of agents and management approaches are available to the practicing oncologist, with variable efficacy and data to support their use. 1 Patients who develop mucositis have twice the risk of developing infections and four times the risk of death compared with patients who do not develop mucositis, and mucositis is associated with considerable financial toxicity. Mucositis can occur throughout the GI tract, from mouth to anus, and symptoms manifest depending on the affected site. The management of mucositis can be quite vexing for both the patient and the oncologist. Oral mucositis is a common and feared adverse effect in patients with cancer who undergo anticancer treatment.
0 Comments
Leave a Reply. |