Fregnani Eduardo R, Epstein Joel B, Blijlevens Nicole M A, Yarom Noam, Villa Alessandro, Raber-Durlacher Judith E, Gardner Pamela J, Shem Dennis, Beaumont Sophie, Bossi Paolo, Elad Sharon
Centro de Oncologia Molecular, Instituto de Ensino E Pesquisa, Hospital Sírio-Libanês, São Paulo, SP, Brazil.
Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Support Care Cancer. 2025 Sep 13;33(10):851. doi: 10.1007/s00520-025-09806-x.
The MASCC/ISOO Clinical Practice Statement (CPS) endeavors to develop a succinct instrument for clinicians, encapsulating essential practical information requisite for the management of oral complications in oncology patients. This CPS specifically addresses the management of oral complications associated with immunotherapy.
This CPS was formulated through a rigorous literature review, followed by a structured discussion among a consortium of leading experts, members of the Oral Care Study Group of MASCC/ISOO. Immunotherapeutic agents were identified utilizing PubMed, and then they were matched with the National Cancer Institute's compendium of Food and Drug Administration-approved immunotherapy drugs. The statement integrated information from the literature about the management of oral immune-related adverse events (irAEs), extrapolation from literature about the management of similar oral diseases, and the working group's clinical experience. The information is systematically presented in concise bullet points and tables, thereby creating a succinct manual delineating the optimal standard of care.
Oral irAEs encompass a range of mucosal and gingival conditions, dysgeusia, dysphagia, and xerostomia/hyposalivation. The management of oral toxicities is contingent upon the severity of the symptoms. Topical steroids and immunomodulators are frequently utilized as first-line therapies for oral mucosal toxicities, and topical anesthetics are employed for pain management. Treatment strategies for dysgeusia primarily focus on symptom management. This CPS also provides a guide for oral and dental care for patients undergoing immunotherapy.
The management of oral toxicities induced by immunotherapy is intended to mitigate patient discomfort, enhance healing, and regain oral function. Optimal management practices necessitate a collaborative approach between medical professionals and oral health specialists.
MASCC/ISOO临床实践声明（CPS）致力于为临床医生开发一种简洁的工具，囊括肿瘤患者口腔并发症管理所需的基本实用信息。本CPS特别针对免疫治疗相关口腔并发症的管理。
本CPS通过严格的文献综述制定，随后由MASCC/ISOO口腔护理研究组的一批顶尖专家进行结构化讨论。利用PubMed识别免疫治疗药物，然后将其与美国国立癌症研究所的食品药品监督管理局批准的免疫治疗药物汇编进行匹配。该声明整合了文献中关于口腔免疫相关不良事件（irAE）管理的信息、从类似口腔疾病管理文献中推断的信息以及工作组的临床经验。这些信息以简洁的要点和表格系统呈现，从而创建了一本简洁的手册，描绘了最佳护理标准。
口腔irAE包括一系列黏膜和牙龈病症、味觉障碍、吞咽困难以及口干症/唾液分泌过少。口腔毒性的管理取决于症状的严重程度。局部用类固醇和免疫调节剂常被用作口腔黏膜毒性的一线治疗药物，局部麻醉剂用于疼痛管理。味觉障碍的治疗策略主要集中在症状管理。本CPS还为接受免疫治疗的患者提供口腔和牙齿护理指南。
免疫治疗引起的口腔毒性管理旨在减轻患者不适、促进愈合并恢复口腔功能。最佳管理实践需要医学专业人员和口腔健康专家之间的协作方法。
