Emerging evidence on the pathobiology of mucositis

Al‐Dasooqi, Noor; Sonis, Stephen T.; Bowen, Joanne M.; Bateman, Emma; Blijlevens, Nicole M A; Gibson, Rachel J.; Logan, Richard M.; Nair, Raj; Stringer, Andrea M.; Yazbeck, Roger; Sharon, Elad; Lalla, Rajesh V.

doi:10.1007/s00520-013-1810-y

Cited by 144 publications

(109 citation statements)

References 97 publications

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“…This contrasts with oral mucositis caused by conventional high‐dose chemotherapy and for which the pathobiology has been studied for the past two decades (Fig. 2) 2, 6, 23, 24, 25, 26, 27. Insights into the mechanism of action of mTOR inhibitors and naturally occurring oral mucosal lesions such as recurrent aphthous ulceration may thus be valuable in informing future research directions involving mIAS.…”

Section: Phenotype Incidence and Pathobiology Of Mtor Inhibitor–assmentioning

confidence: 99%

Oral mucosal injury caused by mammalian target of rapamycin inhibitors: emerging perspectives on pathobiology and impact on clinical practice

et al. 2016

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In recent years oral mucosal injury has been increasingly recognized as an important toxicity associated with mammalian target of rapamycin (mTOR) inhibitors, including in patients with breast cancer who are receiving everolimus. This review addresses the state‐of‐the‐science regarding mTOR inhibitor‐associated stomatitis (mIAS), and delineates its clinical characteristics and management. Given the clinically impactful pain associated with mIAS, this review also specifically highlights new research focusing on the study of the molecular basis of pain. The incidence of mIAS varies widely (2–78%). As reported across multiple mTOR inhibitor clinical trials, grade 3/4 toxicity occurs in up to 9% of patients. Managing mTOR‐associated oral lesions with topical oral, intralesional, and/or systemic steroids can be beneficial, in contrast to the lack of evidence supporting steroid treatment of oral mucositis caused by high‐dose chemotherapy or radiation. However, steroid management is not uniformly efficacious in all patients receiving mTOR inhibitors. Furthermore, technology does not presently exist to permit clinicians to predict a priori which of their patients will develop these lesions. There thus remains a strategic need to define the pathobiology of mIAS, the molecular basis of pain, and risk prediction relative to development of the clinical lesion. This knowledge could lead to novel future interventions designed to more effectively prevent mIAS and improve pain management if clinically significant mIAS lesions develop.

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Section: Phenotype Incidence and Pathobiology Of Mtor Inhibitor–assmentioning

confidence: 99%

Oral mucosal injury caused by mammalian target of rapamycin inhibitors: emerging perspectives on pathobiology and impact on clinical practice

et al. 2016

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“…Epithelial tissue and ECM play a significant role in maintaining the integrity and function of the epithelial layer [2,9]. Intercellular occluding junctions act as a selectively permeable barrier to fluid flow between cells.…”

Section: Tissue Integritymentioning

confidence: 99%

“…Intercellular occluding junctions act as a selectively permeable barrier to fluid flow between cells. A variety of physiological and pharmacological stimuli can modulate the barrier properties 9 . A number of studies have demonstrated drastic changes in tight junction permeability resulting from the action of certain cytokines, such as tumor necrosis factor (TNF-α), IL-1 and IL-6 7,[10][11][12] .…”

Section: Tissue Integritymentioning

confidence: 99%

Immunopathogenesis of Oral Mucositis Induced by Chemotherapy and/or Radiotherapy: State of Art

Dantas

Martins

Lima³

et al. 2017

BJMHH

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| Introduction:Oral mucositis is a common and worrying clinical condition in patients undergoing radiotherapy of the head and neck regions and aggressive chemotherapy. Mucosits manifests as a continuous process, which begins with erythematous and atrophic lesions that can progress to very painful ulcers. The immunopathogenesis of oral mucositis is considered a complex cascade of biological events, and advances on its understanding might result in promising and effective therapies. Objectives: The aim of this study is to highlight the recent findings of the immunopathogenesis of oral mucositis induced by chemotherapy and / or radiotherapy and their possible therapeutic agents. Material and methods: Scientific articles were selected in Pubmed and LILACS basis from December 2015 to May 2016, using the key words in English "mucositis etiopathogenesis" and "mucositis". Were found in Pubmed 107 articles and LILACS 61. The articles were selected after reading and were chosen those which reported detail on the immunopathology of oral mucositis, and an update on the biological causes of this clinical condition. Results and conclusion: The literature indicates that histopathological changes related to oral mucositis, including apoptotic phenomenon, the action of certain chemical mediators and the influence of the oral cavity microbiota promote a better understanding of the immunopathogenesis of this type of injury and their biological development. Therefore, additional clinical studies based on scientific evidence are needed to get a better understanding of the immunopathology of oral mucositis and the determination of preventive agents and effective therapeutic for this deleterious effect arising from antineoplastic treatment.

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“…For most other combinations as well as most monotherapies, rates of 10-20% are common [25]. Lack of oral care, xerostomia, genetic factors, renal/hepatic insufficiency, and previous antitumor therapy of the head and neck area are known to increase the risk of mucositis [23]. Symptoms may range from painless erythema to ulceration, bleeding, and pain.…”

Section: Mucositismentioning

confidence: 99%

“…The pathogenesis is believed to be a complex mechanism of damage to DNA, upregulation of proinflammatory cytokines and enzymes, apoptosis, ulceration, as well as secondary infection [23]. With novel therapies, oral toxicities may present in various different ways [24], including, but not limited to, dysgeusia, aphthoid lesions, mucosal bleeding, xerostomia, glossitis, lichenoid reactions, as well as hyperkeratosis and gingival hyperplasia.…”

Section: Mucositismentioning

confidence: 99%

Prophylaxis and Management of Skin Toxicities

2019

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Skin toxicity is a common problem not only when treating breast cancer but in all cancer types. Visible on the surface, these side effects come not just with burdening symptoms but also with stigmatization. With increasing diversity in therapeutic options, dermatologic side effects are also becoming increasingly complex and more challenging for the clinician. We reviewed the most common dermatologic side effects of current anticancer therapy, including toxicity induced by chemotherapy, targeted therapy, and immunotherapy. In particular, we focus on xerosis and pruritus, (acneiform) exanthema, hand-foot syndrome, nail toxicities, alopecia, and mucositis. We propose measures for the prevention and management of these side effects based on current literature. With high incidences in both chemotherapy and targeted therapy, prophylactic measures are crucial to reducing the incidence and severity of skin toxicity and therefore key to therapy adherence. Appropriate management of these toxicities will help avoid unnecessary treatment discontinuation.

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Emerging evidence on the pathobiology of mucositis

Cited by 144 publications

References 97 publications

Oral mucosal injury caused by mammalian target of rapamycin inhibitors: emerging perspectives on pathobiology and impact on clinical practice

Oral mucosal injury caused by mammalian target of rapamycin inhibitors: emerging perspectives on pathobiology and impact on clinical practice

Immunopathogenesis of Oral Mucositis Induced by Chemotherapy and/or Radiotherapy: State of Art

Prophylaxis and Management of Skin Toxicities

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