Is Pilocarpine Effective in Preventing Radiation-Induced Xerostomia? A Systematic Review and Meta-analysis

Yang, Wei‐En; Liao, Guiqing; Hakim, Samer G.; Ouyang, Dai-qiao; Ringash, Jolie; Su, Yu‐xiong

doi:10.1016/j.ijrobp.2015.11.012

Cited by 37 publications

(27 citation statements)

References 42 publications

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“…Pilocarpine was extensively studied concurrently with RT and its protective effect has recently been confirmed by meta-analysis of 8 randomized phase III studies, though only on unstimulated salivary flow [29]. In post-RT patients who have already developed xerostomia, the use of pilocarpine can also be recommended for the improvement of xerostomia [30] (Table 1).…”

Section: Xerostomiamentioning

confidence: 99%

Treatment of late sequelae after radiotherapy for head and neck cancer

Strojan

Hutcheson

Eisbruch

et al. 2017

Cancer Treatment Reviews

242

171

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Radiotherapy (RT) is used to treat approximately 80% of patients with cancer of the head and neck. Despite enormous advances in RT planning and delivery, a significant number of patients will experience radiation-associated toxicities, especially those treated with concurrent systemic agents. Many effective management options are available for acute RT-associated toxicities, but treatment options are much more limited and of variable benefit among patients who develop late sequelae after RT. The adverse impact of developing late tissue damage in irradiated patients may range from bothersome symptoms that negatively affect their quality of life to severe life-threatening complications. In the region of the head and neck, among the most problematic late effects are impaired function of the salivary glands and swallowing apparatus. Other tissues and structures in the region may be at risk, depending mainly on the location of the irradiated tumor relative to the mandible and hearing apparatus. Here, we review the available evidence on the use of different therapeutic strategies to alleviate common late sequelae of RT in head and neck cancer patients, with a focus on the critical assessment of the treatment options for xerostomia, dysphagia, mandibular osteoradionecrosis, trismus, and hearing loss.

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Section: Xerostomiamentioning

confidence: 99%

Treatment of late sequelae after radiotherapy for head and neck cancer

Strojan

Hutcheson

Eisbruch

et al. 2017

Cancer Treatment Reviews

242

171

View full text Add to dashboard Cite

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“…The toxic effects observed for BcAEF in the acute toxicity protocol were quite similar to those described for pilocarpine, the alkaloid extracted from Pilocarpus microphyllus leaves [ 19 ]. Pilocarpine is a cholinergic agonist used as convulsive inductor in non-clinical epilepsy models [ 20 ] and to treat xerostomia by stimulation of saliva production [ 21 ]. To avoid toxic effects during pharmacological evaluations, a 30 mg kg −1 dose (10 folds lower than the toxic dose) of BcAEF was chosen to evidence the potential antitumor and anti-inflammatory effects.…”

Section: Discussionmentioning

confidence: 99%

In Silico, In Vitro, and In Vivo Antitumor and Anti-Inflammatory Evaluation of a Standardized Alkaloid-Enriched Fraction Obtained from Boehmeria caudata Sw. Aerial Parts

et al. 2020

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In the context of the cancer-inflammation relationship and the use of natural products as potential antitumor and anti-inflammatory agents, the alkaloid-enriched fraction of Boehmeriacaudata (BcAEF) aerial parts was evaluated. In vitro antiproliferative studies with human tumor cell lines showed high activity at low concentrations. Further investigation on NCI-H460 cells showed an irreversible effect on cell proliferation, with cell cycle arrest at G2/M phase and programmed cell death induction. Molecular docking studies of four alkaloids identified in BcAEF with colchicine’s binding site on β-tubulin were performed, suggesting (−)-C (15R)-hydroxycryptopleurine as the main inductor of the observed mitotic death. In vivo studies showed that BcAEF was able to reduce Ehrlich tumor volume progression by 30 to 40%. Checking myeloperoxidase activity, BcAEF reduced neutrophils migration towards the tumor. The in vivo anti-inflammatory activity was evaluated by chemically induced edema models. In croton oil-induced ear edema and carrageenan (CG)-induced paw edema models, BcAEF reduced edema around 70 to 80% together with inhibition of activation and/or migration of neutrophils to the inflammatory area. All together the results presented herein show BcAEF as a potent antitumor agent combining antiproliferative and anti-inflammatory properties, which could be further explored in (pre)clinical studies.

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“…A systematic review and meta-analysis including 736 patients confirmed that preventive administration of pilocarpine, a cholinergic agonist, could increase the unstimulated salivary flow rate during RT, with an advantage for only a period of 3-6 months and this may improve patient-reported xerostomia at 6 months and possibly 12 months after treatment has ended (I, B). 68 Long-term use of systemic pilocarpine 5 mg three times a day or cevimeline 30 mg three times a day demonstrated an advantage in reducing xerostomia in irradiated head and neck cancer survivors, with a greater magnitude of benefit for pilocarpine. 68 However, the clinical significance of the obtained benefit is unknown, and the cholinergic AEs of the long-term use (bronchospasm, bradycardia, vasodilation and diarrhoea) should be considered in clinical practice (I, C).…”

Section: Treatmentmentioning

confidence: 99%