Department of Pharmacy Practice, College of Pharmacy, University of New England, 716 Stevens Avenue, College of Pharmacy Building, Room 234, Portland, ME 04103, USA.
Am J Health Syst Pharm. 2012 Jun 15;69(12):1031-7. doi: 10.2146/ajhp100531.
Issues surrounding the prevention and management of severe oral mucositis in patients with head and neck cancer and patients receiving targeted anticancer therapies are reviewed.
Cancer therapy-related mucositis is associated with many negative and potentially life-threatening sequelae. Patients receiving chemoradiotherapy for head and neck cancer are at high risk for severe oral mucositis, but there are currently no definitive recommendations on pharmacologic preventive strategies. Recently published evidence on the use of palifermin to combat oral mucositis during chemoradiotherapy for head and neck cancer is encouraging, with two randomized controlled trials indicating an absolute risk reduction of about 15%; however, palifermin use was not associated with lower rates of mucositis-related treatment delays or chemotherapy dosage reductions, and concerns about optimal dosage and cost-benefit issues persist. Oral mucositis due to targeted therapies for renal cell carcinoma and other disorders (e.g., kinase inhibitors, mammalian target of rapamycin inhibitors) is generally less severe than mucositis caused by conventional cytotoxic chemotherapy. For both types of mucositis, recommended management strategies include good oral hygiene and optimal pain control. Research in this area continues to be complicated by investigators' use of varying terminology and mucositis classification schemes.
Palifermin appears to reduce the frequency of oral mucositis in patients treated for head and neck cancer, but its place in therapy has not been determined. Although the oral complications of targeted therapies are clinically distinct from those of conventional cytotoxic therapy, the literature recommends similar palliative management strategies for both.
综述头颈部癌症患者和接受靶向抗癌治疗患者的严重口腔黏膜炎的预防和管理问题。
癌症治疗相关黏膜炎会引起许多负面的、潜在威胁生命的后果。接受头颈部放化疗的患者有发生严重口腔黏膜炎的高风险，但目前尚无关于药物预防策略的明确建议。最近公布的关于培美曲塞治疗头颈部放化疗相关口腔黏膜炎的证据令人鼓舞，两项随机对照试验表明绝对风险降低约 15%；然而，培美曲塞的使用与减少黏膜炎相关的治疗延迟或化疗剂量减少无关，并且对最佳剂量和成本效益问题仍存在担忧。肾细胞癌和其他疾病（如激酶抑制剂、哺乳动物雷帕霉素靶蛋白抑制剂）的靶向治疗引起的口腔黏膜炎通常比传统细胞毒性化疗引起的黏膜炎轻。对于这两种类型的黏膜炎，推荐的治疗策略包括良好的口腔卫生和最佳的疼痛控制。该领域的研究继续受到研究人员使用不同术语和黏膜炎分类方案的影响。
培美曲塞似乎降低了头颈部癌症治疗患者口腔黏膜炎的发生率，但它在治疗中的地位尚未确定。尽管靶向治疗的口腔并发症与传统细胞毒性治疗的口腔并发症在临床上有所不同，但文献推荐对两者采用类似的姑息治疗策略。
