Systematic review of amifostine for the management of oral mucositis in cancer patients

Nicolatou‐Galitis, Ourania; Sarri, Triantafyllia; Bowen, Joanne M.; Palma, Mario Di; Kouloulias, Vassilis; Niscola, Pasquale; Riesenbeck, D.; Stokman, Monique A.; Tissing, Wim J. E.; Yeoh, Eric; Sharon, Elad; Lalla, Rajesh V.; Isoo,

doi:10.1007/s00520-012-1613-6

Cited by 92 publications

(57 citation statements)

References 45 publications

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“…Amifostine, an antioxidant and cytoprotective agent, has been evaluated in several studies for prevention and treatment of OM but there is little evidence to show that amifostine may prevent OM. 23,28,29 Moreover, one of the main concerns about amifostine administration is the possibility of several adverse reactions including nausea, vomiting and hypotension. 30 Zinc is another antioxidant, which was reported to prevent the occurrence of OM in patients with head and neck cancer who were undergoing radiotherapy.…”

Section: Discussionmentioning

confidence: 99%

N-acetyl cysteine for prevention of oral mucositis in hematopoietic SCT: a double-blind, randomized, placebo-controlled trial

Moslehi

Taghizadeh-Ghehi

Gholami

et al. 2014

Bone Marrow Transplant

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Oral mucositis (OM) is a complication of high-dose chemotherapy (HDC) which is frequently observed in hematopoietic SCT settings. Antioxidant agents have been proposed to prevent OM and therefore N-acetyl cysteine (NAC) could have an important role. In the present study, we conducted a double-blind, randomized, placebo-controlled study to evaluate the NAC effect on OM incidence and severity, and also glutathione peroxidase-1 activity. Leukemia patients undergoing allogeneic hematopoietic SCT preceded by HDC were recruited into the study and received either NAC (100 mg/kg/day) (n = 38) or placebo (n = 42) from the starting day of HDC until day +15 after transplantation. OM was evaluated daily for 21 days after transplantation according to World Health Organization oral toxicity scale. The incidence of severe OM (grades 3-4) was significantly lower in the NAC group (23.7% vs 45.3%, P = 0.04). Moreover, the mean duration of OM was significantly shorter in the intervention group (6.24(2.96) vs 8.12(3.97) days, P = 0.02). The glutathione peroxidase-1 activity was also significantly higher in the NAC group seven days after transplantation (3.38(2.19) vs 2.41(1.70) ng/mL, P = 0.003). It is concluded that parenteral NAC is effective in reducing the incidence of severe cases and the total duration of OM.

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Section: Discussionmentioning

confidence: 99%

N-acetyl cysteine for prevention of oral mucositis in hematopoietic SCT: a double-blind, randomized, placebo-controlled trial

Moslehi

Taghizadeh-Ghehi

Gholami

et al. 2014

Bone Marrow Transplant

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“…The drug is eliminated rapidly from the blood and tissues as its concentration drops by 94% within 6 min after injection, because of which administration shortly before radiation treatment is necessary. In terms of administration routes, intravenous (IV) injection, the current standard path, causes high rates of hypotension and nausea, whereas, although preferable, oral administration is unable to reach an effective concentration (Pamujula et al, 2004;Lu et al, 2011;Nicolatou-Galitis et al, 2012;A et al, 2013). The intra-rectal route was proposed to deliver amifostine in some recent studies; however, patient acceptance and compliance was marginal.…”

Section: Introductionmentioning

confidence: 99%

Sustained-release microspheres of amifostine for improved radio-protection, patient compliance, and reduced side effects

Jin

2016

Drug Delivery

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A biweekly administration of sustained-release microsphere dosage form of amifostine, a radioprotective drug used in radiotherapy, was performed to examine the feasibility to minimize injection frequency and blood concentration-associated side effects. Model animal trials indicated that this subcutaneously injecting microspheres, 50-100 mm in diameter, achieved bi-weekly prolonged radio-protective efficacy and, at the same time, significantly reduced skin irritation than the solution form of amifostine given by the same administration route. In addition, the hypertension associated with blood concentration of amifostine was not observed in the drug-treated rats. The animals given the amifostine microspheres and amifostine showed significantly differences in white blood cell, red blood cell, hematocrit, hemoglobin and spleen tissue histopathology after exposed under a cobalt-60 g-radiation at a dose rate of 1.0 Gy/min for 6 min. The in vitro release profile of amifostine from the micropsheres showed a minor initial burst (less than 20% of total drug loading in the first day of administration), consisting with the side effects observations. The results suggest that amifostine encapsulated in sustained-release microspheres may be an ideal dosage form for prolonged radio-protective efficacy and improved patient compliance.

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“…These may arise due to direct effects of treatment on the soft and hard oral tissues, or indirect damage through systemic toxicity (6). Oral complications diminish the quality of life (QOL) of oncology patient, impact the completion of planned treatment, and increase morbidity and possibly mortality (1,2,(6)(7)(8)(9). Additionally, preexisting dental and periodontal disease may exacerbate causing pain, local, regional and systemic infection in the setting of malignant disease, and these conditions may not be effectively managed when the patient is medically compromised.…”

mentioning

confidence: 99%

Patient-reported outcomes for immediate identification of dental care needs

Güneri

Epstein

Raber-Durlacher

et al. 2015

Forum of Clinical Oncology

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Aim: Dental treatment is necessary in oncology patients since pre-existing oro-dental disease may influence cancer treatment and prognosis. This study investigated the applicability of two indices in reflecting the actual oral health status of 100 non-cancer patients who were admitted for dental complaints/routine controls. Methods: The radiographic examination results and the decayed, missed, filled teeth score represented the ‘actual oro-dental status’. The simplified oral hygiene index was utilised for oral hygiene determination, and general oral health assessment index was used to establish the self-perceived oral health. Results: No correlation was observed between actual oro-dental status and the simplified oral hygiene index (p = 0.27), but the relationship between oro-dental status and general oral health assessment index was significant (p = 0.026). Items 9, 5 and 1 (How often were you concerned about problems with your teeth, gums or dentures? How often were you able to eat anything without feeling discomfort? How often did you limit the kinds or amounts of food you eat because of problems with your teeth or dentures?) presented correlation (r = −0.285, r = 0.268, and r = −0.248). Conclusion: Three items of GOHAI (Geriatric Oral Health Assessment Index) may be used to identify the requisite of dental treatment in patients and to aid in immediate dental treatment planning.

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Systematic review of amifostine for the management of oral mucositis in cancer patients

Cited by 92 publications

References 45 publications

N-acetyl cysteine for prevention of oral mucositis in hematopoietic SCT: a double-blind, randomized, placebo-controlled trial

N-acetyl cysteine for prevention of oral mucositis in hematopoietic SCT: a double-blind, randomized, placebo-controlled trial

Sustained-release microspheres of amifostine for improved radio-protection, patient compliance, and reduced side effects

Patient-reported outcomes for immediate identification of dental care needs

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