Department of Pharmacy, Kyoto-Katsura Hospital, 17, Yamadahiraocho, Kyoto-shi Nishikyo-ku, Kyoto, 615-8256, Japan.
Department of Pharmacy, Shiga University of Medical Science Hospital, Seta Tsukinowa-cho, Otsu, Shiga, 520-2192, Japan.
BMC Cancer. 2018 Oct 5;18(1):957. doi: 10.1186/s12885-018-4862-z.
Chemotherapy-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).
We 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.
Thirty-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.
Pmab-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.
化疗引起的口腔黏膜炎会降低生活质量。不同抗表皮生长因子受体（EGFR）抗体联合细胞毒性药物在结直肠癌中的口腔黏膜炎严重程度差异尚不清楚。本研究旨在探讨帕尼单抗（Pmab）和西妥昔单抗（Cmab）联合氟尿嘧啶（5-FU）的口腔黏膜炎差异。
我们进行了一项回顾性队列研究。共纳入 75 例接受 EGFR 抗体联合 FOLFOX、FOLFIRI 或 5-FU/亚叶酸钙作为一线至三线治疗的结直肠癌门诊患者。主要终点为 2-3 级口腔黏膜炎的发生率。次要终点为口腔黏膜炎发病时间。我们还比较了两组患者关注的毒性、皮肤毒性、低镁血症和中性粒细胞减少症以及治疗失败时间（TTF）的发生率。
32 例患者接受 Pmab 治疗，43 例患者接受 Cmab 治疗。两组患者的特征相似。Pmab 组 2-3 级口腔黏膜炎发生率明显高于 Cmab 组（31.3%比 9.3%，P<0.05）。此外，Pmab 组 3 级口腔黏膜炎发生率明显更高（18.8%比 0%，P<0.01）。Pmab 组出现最严重口腔黏膜炎的平均（SD）周期为 3.0（2.9），Cma 组为 2.3（1.7）（P=0.29）。口腔黏膜炎表现为舌炎和唇炎。其他毒性发生率如下（Pmab 比 Cmab）：2-3 级皮肤毒性：68.8%比 74.4%（P=0.61），2-3 级低镁血症：9.3%比 7.0%（P=1.00），3-4 级中性粒细胞减少症：28.1%比 37.2%（P=0.46）。Pmab 组和 Cmab 组的中位 TTF 无显著差异，即 Pmab 组为 223 天，Cma 组为 200 天（P=0.39）。
与 Cmab 相比，Pmab 为基础的化疗导致的口腔黏膜炎程度明显更高。应密切监测口腔状况，并为接受 Pmab 为基础的化疗的患者提供早期支持性护理。
