Perspectives on cancer therapy-induced mucosal injury

Pathogenesis, measurement, epidemiology, and consequences for patients

Authors

  • Stephen T. Sonis D.M.D., D.M.Sc.,

    Corresponding author
    1. Division of Oral Medicine, Brigham & Women's Hospital, Boston, Massachusetts
    • Division of Oral Medicine, Brigham & Women's Hospital, 25 Francis Street, Boston, MA 02115
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    • Fax: (617) 232-8970

    • Dr. Sonis has served as a consultant for Biomodels and Affiliates, LLC (Wellesley, MA).

  • Linda S. Elting Dr.P.H.,

    1. Department of Biostatistics and Applied Mathematics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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    • Dr. Elting has received speaker's honoraria from McNeill Pharmaceuticals and Endo Pharmaceuticals (Chadds Ford, PA).

  • Dorothy Keefe M.D.,

    1. Department of Medical Oncology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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    • Dr. Keefe has received research funding and speaker's honoraria from Amgen.

  • Douglas E. Peterson D.M.D., Ph.D.,

    1. Department of Oral Diagnosis, University of Connecticut Health Center, Farmington, Connecticut
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    • Dr. Peterson has served as a paid consultant for Aesgen, Inc. (Princeton, NJ).

  • Mark Schubert D.D.S., M.S.D.,

    1. Department of Oral Medicine, Fred Hutchinson Cancer Research Center, Seattle, Washington
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    • Dr. Schubert is a member of the Advisory Boards for Endo Pharmaceuticals, OSI Pharmaceuticals, and McNeill Pharmaceuticals and has received consulting fees per meeting plus expenses.

  • Martin Hauer-Jensen M.D., Ph.D.,

    1. Arkansas Cancer Research Center, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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  • B. Nebiyou Bekele Ph.D.,

    1. Department of Biostatistics and Applied Mathematics, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
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  • Judith Raber-Durlacher D.D.S.,

    1. Department of Clinical Oncology, Leiden University Medical Center, Leiden, The Netherlands
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  • J. Peter Donnelly Ph.D.,

    1. Department of Hematology, Nijmegen University Hospital, Nijmegen, The Netherlands
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  • Edward B. Rubenstein M.D.

    1. Department of Palliative Care and Rehabilitation Medicine, The University of Texas M. D. Anderson Cancer Center, Houston, Texas
    Current affiliation:
    1. MGI Pharma, Bloomington, Minnesota
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    • Dr. Rubenstein has received research funding from and is a member of the speakers program and advisory board at Merck (Whitehouse Station, NJ); he owns common stock in and is a member of the advisory board at MGI Pharma; and he is a member of the advisory boards at Endo Pharmaceuticals, McNeil Consumer and Specialty Pharmaceuticals, and OSI Pharmaceuticals.


Abstract

BACKGROUND

A frequent complication of anticancer treatment, oral and gastrointestinal (GI) mucositis, threatens the effectiveness of therapy because it leads to dose reductions, increases healthcare costs, and impairs patients' quality of life. The Multinational Association of Supportive Care in Cancer and the International Society for Oral Oncology assembled an international multidisciplinary panel of experts to create clinical practice guidelines for the prevention, evaluation, and treatment of mucositis.

METHODS

The panelists examined medical literature published from January 1966 through May 2002, presented their findings at two separate conferences, and then created a writing committee that produced two articles: the current study and another that codifies the clinical implications of the panel's findings in practice guidelines.

RESULTS

New evidence supports the view that oral mucositis is a complex process involving all the tissues and cellular elements of the mucosa. Other findings suggest that some aspects of mucositis risk may be determined genetically. GI proapoptotic and antiapoptotic gene levels change along the GI tract, perhaps explaining differences in the frequency with which mucositis occurs at different sites. Studies of mucositis incidence in clinical trials by quality and using meta-analysis techniques produced estimates of incidence that are presented herein for what to our knowledge may be a broader range of cancers than ever presented before.

CONCLUSIONS

Understanding the pathobiology of mucositis, its incidence, and scoring are essential for progress in research and care directed at this common side-effect of anticancer therapies. Cancer 2004;100(9 Suppl):1995–2025. © 2004 American Cancer Society.

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