Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients and clinical practice guidelines

Abstract

Purpose To update the clinical practice guidelines for the use of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the prevention and/or treatment of oral mucositis (OM). Methods A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the 2014 MASCC/ ISOO clinical practice guidelines. Based on the evidence level, the following guidelines were determined: Recommendation, Suggestion, and No Guideline Possible. Results A total of 9 new papers were identified within the scope of this section, adding to the 62 papers reviewed in this section previously. A new Suggestion was made for topical 0.2% morphine for the treatment of OM-associated pain in head and neck (H&N) cancer patients treated with RT-CT (modification of previous guideline). A previous Recommendation against the use of sucralfate-combined systemic and topical formulation in the prevention of OM in solid cancer treatment with CT was changed from Recommendation Against to No Guideline Possible. Suggestion for doxepin and fentanyl for the treatment of mucositisassociated pain in H&N cancer patients was changed to No Guideline Possible.

MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy

“…New evidence was identified for the following agents: morphine (topical), sucralfate (topical/systemic), fluconazole (systemic), miconazole (topical and systemic), mucoadhesive hydrogel (topical; MuGard), polyvinylpyrrolidone (topical; Gelclair), doxepin (topical), and fentanyl (transdermal). 17 The new evidence supported the suggestion in favor of topical morphine (Table 1). 17 New studies on sucralfate did not pertain to the clinical settings referred to in the 2014 guidelines.…”

“…17 The new evidence supported the suggestion in favor of topical morphine (Table 1). 17 New studies on sucralfate did not pertain to the clinical settings referred to in the 2014 guidelines. Accordingly, the recommendations against sucralfate for 3 clinical settings remained unchanged.…”

“…For more detailed results, including lists of all reviewed articles, please refer to the published article for each section. [11][12][13][14][15][16][17][18] Guidelines that are new or were changed compared with the 2014 guidelines are discussed below and appear in Table 1. Guidelines for which there was new evidence but the statements remained unchanged appear in Table 1 only.…”

“…The previous 2014 recommendations against Iseganan, polymyxin, tobramycin, and amphotericin B (PTA) paste; and bacitracin, clotrimazole, and gentamicin (BCoG) lozenges remain unchanged because there were no new data (see Supporting Table 1). 17…”

Oncological-Therapy Related Oral Mucositis as an Interdisciplinary Problem—Literature Review

“…Topical anesthetic agents are very common usedamong patients with oral mucositis and clinical experience suggests that they can be beneficial in some patients to provide temporary relief. However, topical morphine concentrations are not clearly defined and range from 0.08 for the gel to 0.2% to 2% for the rinse which can lead to a conclusion that this topic requires further evaluation [37].…”