Topical polyene antifungals in hematopoietic cell transplant patients: tolerability and efficacy

J Oral Pathology Medicine

Raber-Durlacher

et al. 2011

Section: Discussionsupporting

confidence: 91%

The antimicrobial effect of Iseganan HCl oral solution in patients receiving stomatotoxic chemotherapy: analysis from a multicenter, double‐blind, placebo‐controlled, randomized, phase III clinical trial

Sharon

J Oral Pathology Medicine

Raber-Durlacher

et al. 2011

“…The addition of topical antifungals to systemic prophylaxis has been shown to reduce oral colonization, which can lead to a reduced risk of subsequent local and systemic infection ( Table 2). 132 Oral candidiasis is most often caused by Candida albicans, but increasing cases of Candida krusei, Cronobacter dublinensis, and other species that may increase resistance to fluconazole have been recognized. These cases may be managed with an increased dose, a change in antifungal treatment, and the addition of topical agents.…”

Section: Oral Infections Oropharyngeal Candidiasismentioning

confidence: 99%

Oral complications of cancer and cancer therapy

CA A Cancer J Clinicians

Thariat

Bensadoun

et al. 2012

414

356

Answer questions and earn CME/CNEOral complications resulting from cancer and cancer therapies cause acute and late toxicities that may be underreported, underrecognized, and undertreated. Recent advances in cancer treatment have led to changes in the incidence, nature, and severity of oral complications. As the number of survivors increases, it is becoming increasingly recognized that the aggressive management of oral toxicities is needed to ensure optimal long‐term oral health and general well‐being. Advances in care have had an impact on previously recognized oral complications and are leading to newly recognized adverse effects. Here, the authors briefly review advances in cancer therapy, including recent advances in surgery, oral care, radiation therapy, hematopoietic cell transplantation, and medical oncology; describe how these advances affect oral health; and discuss the frequent and/or severe oral health complications associated with cancer and cancer treatment and their effect upon long‐term health. Although some of the acute oral toxicities of cancer therapies may be reduced, they remain essentially unavoidable. The significant impact of long‐term complications requires increased awareness and recognition to promote prevention and appropriate intervention. It is therefore important for the primary oncologist to be aware of these complications so that appropriate measures can be implemented in a timely manner. Prevention and management is best provided via multidisciplinary health care teams, which must be integrated and communicate effectively in order to provide the best patient care in a coordinated manner at the appropriate time. CA Cancer J Clin 2012. © 2012 American Cancer Society.

“…Topical polyenes rinses were assessed in 40 patients receiving HCT, and were shown to have an additive effect to systemic fluconazole prophylaxis in reducing oral colonisation in HCT patients in a randomised trial of nystatin suspension versus amphotericin B [166]. However, tolerability of nystatin and amphotericin B suspension was limited during chemotherapy.…”

Section: Topical Polyenes/azolesmentioning

confidence: 99%

Emerging approaches for prophylaxis and management of oropharyngeal mucositis in cancer therapy

Expert Opinion on Emerging Drugs

Klasser

2006

Oral mucositis is a common treatment-limiting side effect of cancer therapy that may have a significant impact on quality of life and on the cost of care. Oral mucositis is the most distressing complication of cancer therapy as reported by head and neck cancer patients, in patients receiving dose-dense myelosuppressive chemotherapy and in patients receiving haematopoietic stem cell transplant. Mucositis may increase the risk of local and systemic infection, particularly in myelosuppressed patients. Severe oral mucositis can lead to the need to interrupt or discontinue cancer therapy, and thus may impact cure of the primary disease. Current care of patients with mucositis is essentially palliative, and includes appropriate oral hygiene, nonirritating diet and oral care products, topical palliative mouth rinses, topical anaesthetics and use of systemic opioid analgesics. Emerging approaches for prevention and treatment of oral mucositis are developing based on an increasing understanding of the pathobiology of mucosal damage and repair. New interventions are expected to be administered based on the mechanisms of initiation, progression and resolution of the condition. The approval by the FDA of keratinocyte growth factor (palifermin; Amgen) in 2004 represents a new step in prevention of oral mucositis in stem cell transplant patients based on the increasing understanding of the pathogenesis of mucositis. Progress in the prevention and management of mucositis will improve quality of life, reduce cost of care and facilitate completion of more intensive cancer chemotherapy and radiotherapy protocols. Improved management of mucositis may allow implementation of cancer treatment protocols that are currently excessively mucotoxic, but have potentially higher cure rates of the malignant disease.