Comparative Efficacy and Safety of Interventions for Preventing Chemotherapy-induced Oral Mucositis in Adult Cancer Patients: a Systematic Review and Network Meta-analysis

Overview

Journal Eur J Hosp Pharm

Publisher BMJ Publishing Group

Specialty Pharmacy

Date 2020 Mar 6

PMID 32133137

Citations 6

Authors

Preyanate Wilairat

Kirati Kengkla

Thanatchai Kaewpanan

Jirapat Kaewthong

Sorave Ruankon

Chulalak Subthaweesin

David D Stenehjem

Surasak Saokaew

Affiliations

Soon will be listed here.

Abstract

Objective: To examine the comparative efficacy and safety of interventions for preventing chemotherapy-induced oral mucositis (OM) in adult cancer patients.

Methods: We searched PubMed, Embase and the Cochrane Central systematically for the randomised control trials (RCTs) of interventions for preventing OM. Network meta-analysis (NMA) was performed to estimate risk ratios (RR) and 95% confidence intervals (CI) from both direct and indirect evidence. The primary outcome was any grade of OM. Secondary outcomes were mild-moderate OM, severe OM and adverse events, such as taste disturbance and gastrointestinal adverse events. This study was registered with PROSPERO, number CRD42016052489.

Results: A total of 29 RCTs with 2348 patients (median age, 56.1 years; 57.5% male) were included. Cryotherapy was associated with a significantly lower risk of OM than control (RR 0.51, 95% CI 0.38 to 0.68), and zinc sulphate (RR 0.47, 95% CI 0.23 to 0.97), but not significantly lower than sucralfate and palifermin. No significant differences were observed between cryotherapy and control for taste disturbance and gastrointestinal adverse events. Palifermin was associated with the highest risk of taste disturbance.

Conclusions: This NMA suggests that cryotherapy was the most effective intervention for preventing chemotherapy-induced OM with a safety profile similar to control, but not significantly lower than sucralfate and palifermin. Large RCTs are needed to confirm these findings.

Citing Articles

Interventions for the Prevention of Oral Mucositis in Patients Receiving Cancer Treatment: Evidence from Randomised Controlled Trials.

Colella G, Emiliano Boschetti C, Vitagliano R, Colella C, Jiao L, King-Smith N Curr Oncol. 2023; 30(1):967-980.

PMID: 36661723 PMC: 9858113. DOI: 10.3390/curroncol30010074.

Sucralfate enemas reduce the oxidative tissue damage and preserves the contents of E-cadherin and ?-catenin in colonic mucosa without fecal stream.

Sato D, Campos F, Kotze P, Mendonca R, Kanno D, Pereira J Acta Cir Bras. 2021; 36(10):e361007.

PMID: 34852133 PMC: 8650803. DOI: 10.1590/ACB361007.

Safety, Precautions, and Modalities in Cancer Rehabilitation: an Updated Review.

Zheng J, Mixon A, McLarney M Curr Phys Med Rehabil Rep. 2021; 9(3):142-153.

PMID: 34178432 PMC: 8214054. DOI: 10.1007/s40141-021-00312-9.

Cooperation between ENT surgeon and dentist in head and neck oncology.

Berrone M, Lajolo C, De Corso E, Settimi S, Rupe C, Crosetti E Acta Otorhinolaryngol Ital. 2021; 41(Suppl. 1):S124-S137.

PMID: 34060528 PMC: 8172104. DOI: 10.14639/0392-100X-suppl.1-41-2021-13.

Effect of cryotherapy in preventing mucositis associated with the use of 5-fluorouracil.

Rodrigues A, Aguiar M, Oliveira P, Alves N, Silva R, Vitorino W Rev Lat Am Enfermagem. 2020; 28:e3363.

PMID: 33084773 PMC: 7575237. DOI: 10.1590/1518-8345.3953.3363.

References

Pico , Naccache . Mucositis: Its Occurrence, Consequences, and Treatment in the Oncology Setting. Oncologist. 1999; 3(6):446-451. View

Lumley T . Network meta-analysis for indirect treatment comparisons. Stat Med. 2002; 21(16):2313-24. DOI: 10.1002/sim.1201. View

Elting L, Shih Y, Stiff P, Bensinger W, Cantor S, Cooksley C . Economic impact of palifermin on the costs of hospitalization for autologous hematopoietic stem-cell transplant: analysis of phase 3 trial results. Biol Blood Marrow Transplant. 2007; 13(7):806-13. DOI: 10.1016/j.bbmt.2007.03.004. View

Ala S, Saeedi M, Janbabai G, Ganji R, Azhdari E, Shiva A . Efficacy of Sucralfate Mouth Wash in Prevention of 5-fluorouracil Induced Oral Mucositis: A Prospective, Randomized, Double-Blind, Controlled Trial. Nutr Cancer. 2016; 68(3):456-63. DOI: 10.1080/01635581.2016.1153666. View

Hartmann J, von Vangerow A, Fels L, Knop S, STOLTE H, Kanz L . A randomized trial of amifostine in patients with high-dose VIC chemotherapy plus autologous blood stem cell transplantation. Br J Cancer. 2001; 84(3):313-20. PMC: 2363753. DOI: 10.1054/bjoc.2000.1611. View

Nooka A, Johnson H, Kaufman J, Flowers C, Langston A, Steuer C . Pharmacoeconomic analysis of palifermin to prevent mucositis among patients undergoing autologous hematopoietic stem cell transplantation. Biol Blood Marrow Transplant. 2014; 20(6):852-857. PMC: 4063211. DOI: 10.1016/j.bbmt.2014.02.025. View

Cardona A, Balouch A, Abdul M, Sedghizadeh P, Enciso R . Efficacy of chlorhexidine for the prevention and treatment of oral mucositis in cancer patients: a systematic review with meta-analyses. J Oral Pathol Med. 2017; 46(9):680-688. DOI: 10.1111/jop.12549. View

Veroniki A, Vasiliadis H, Higgins J, Salanti G . Evaluation of inconsistency in networks of interventions. Int J Epidemiol. 2013; 42(1):332-45. PMC: 5411010. DOI: 10.1093/ije/dys222. View

DerSimonian R, Laird N . Meta-analysis in clinical trials. Control Clin Trials. 1986; 7(3):177-88. DOI: 10.1016/0197-2456(86)90046-2. View

10.

Nottage M, McLachlan S, Brittain M, Oza A, Hedley D, Feld R . Sucralfate mouthwash for prevention and treatment of 5-fluorouracil-induced mucositis: a randomized, placebo-controlled trial. Support Care Cancer. 2003; 11(1):41-7. DOI: 10.1007/s00520-002-0378-8. View

11.

Meropol N, Somer R, Gutheil J, Pelley R, Modiano M, Rowinsky E . Randomized phase I trial of recombinant human keratinocyte growth factor plus chemotherapy: potential role as mucosal protectant. J Clin Oncol. 2003; 21(8):1452-8. DOI: 10.1200/JCO.2003.10.079. View

12.

Bradstock K, Link E, Collins M, Di Iulio J, Lewis I, Schwarer A . A randomized trial of prophylactic palifermin on gastrointestinal toxicity after intensive induction therapy for acute myeloid leukaemia. Br J Haematol. 2014; 167(5):618-25. DOI: 10.1111/bjh.13086. View

13.

Gabriel D, Shea T, Olajida O, Serody J, Comeau T . The effect of oral mucositis on morbidity and mortality in bone marrow transplant. Semin Oncol. 2004; 30(6 Suppl 18):76-83. DOI: 10.1053/j.seminoncol.2003.11.040. View

14.

Spencer A, Horvath N, Gibson J, Prince H, Herrmann R, Bashford J . Prospective randomised trial of amifostine cytoprotection in myeloma patients undergoing high-dose melphalan conditioned autologous stem cell transplantation. Bone Marrow Transplant. 2005; 35(10):971-7. DOI: 10.1038/sj.bmt.1704946. View

15.

Sorensen J, Skovsgaard T, Bork E, Damstrup L, Ingeberg S . Double-blind, placebo-controlled, randomized study of chlorhexidine prophylaxis for 5-fluorouracil-based chemotherapy-induced oral mucositis with nonblinded randomized comparison to oral cooling (cryotherapy) in gastrointestinal malignancies. Cancer. 2008; 112(7):1600-6. DOI: 10.1002/cncr.23328. View

16.

Katranci N, Ovayolu N, Ovayolu O, Sevinc A . Evaluation of the effect of cryotherapy in preventing oral mucositis associated with chemotherapy - a randomized controlled trial. Eur J Oncol Nurs. 2011; 16(4):339-44. DOI: 10.1016/j.ejon.2011.07.008. View

17.

Ferretti G, Raybould T, Brown A, Macdonald J, Greenwood M, Maruyama Y . Chlorhexidine prophylaxis for chemotherapy- and radiotherapy-induced stomatitis: a randomized double-blind trial. Oral Surg Oral Med Oral Pathol. 1990; 69(3):331-8. DOI: 10.1016/0030-4220(90)90295-4. View

18.

Rosen L, Abdi E, Davis I, Gutheil J, Schnell F, Zalcberg J . Palifermin reduces the incidence of oral mucositis in patients with metastatic colorectal cancer treated with fluorouracil-based chemotherapy. J Clin Oncol. 2006; 24(33):5194-200. DOI: 10.1200/JCO.2005.04.1152. View

19.

Baydar M, Dikilitas M, Sevinc A, Aydogdu I . Prevention of oral mucositis due to 5-fluorouracil treatment with oral cryotherapy. J Natl Med Assoc. 2005; 97(8):1161-4. PMC: 2575965. View

20.

Wilairat P, Kengkla K, Kaewpanan T, Kaewthong J, Ruankon S, Subthaweesin C . Comparative efficacy and safety of interventions for preventing chemotherapy-induced oral mucositis in adult cancer patients: a systematic review and network meta-analysis. Eur J Hosp Pharm. 2020; 27(2):103-110. PMC: 7043259. DOI: 10.1136/ejhpharm-2018-001649. View