Cancer Chemotherapy and Pharmacology

, Volume 58, Issue 6, pp 835–837 | Cite as

Panmucositis and chemosensitisation associated with betel quid chewing during dose-dense adjuvant breast cancer chemotherapy

  • Richard J. Epstein
  • Thomas W. T. Leung
  • Polly S. Y. Cheung
Short Communication


Purpose: The severity of chemotherapy-induced oral mucositis has previously been reported to be greater in patients who chew betel quid (areca), an addictive habit shared by hundreds of millions of individuals worldwide. Here, we report a case of fulminant panmucositis complicating dose-dense adjuvant breast cancer treatment in a betel-chewing patient without evidence of other risk factors. Methods: Grade IV mucositis was triggered by the initial use of standard-dose anthracycline chemotherapy, and involved not only the mouth but also the genital and anal mucosa, as well as other severe non-mucosal toxicities. Results: Despite subsequent treatment with dose-reduced CMF and docetaxel regimens—which are seldom associated with mucosal toxicity at these dose intensities in the absence of neutropenia—high-grade oral mucositis continued to complicate the therapeutic course. Conclusion: These observations suggest that the potentiation of chemotherapy-induced mucositis by quid chewing may not be mediated solely by local effects on the oral epithelium, but also involves the systemic absorption of toxic chemosensitising molecules.


Cytotoxic drug treatment Iatrogenic toxicity Areca 



We thank Miranda Ho for secretarial assistance.


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Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Richard J. Epstein
    • 1
    • 2
  • Thomas W. T. Leung
    • 2
  • Polly S. Y. Cheung
    • 3
  1. 1.Division of Haematology/Oncology, Department of MedicineUniversity of Hong KongPokfulamHong Kong
  2. 2.Comprehensive Oncology CentreHong Kong Sanatorium & HospitalHappy ValleyHong Kong
  3. 3.Breast Care CentreHong Kong Sanatorium & HospitalHappy ValleyHong Kong

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