Epigallocatechin-3-gallate mouthwash protects mucosa from radiation-induced mucositis in head and neck cancer patients: a prospective, non-randomised, phase 1 trial

  • Wanqi Zhu
  • Hui Mei
  • Li Jia
  • Hanxi ZhaoEmail author
  • Xiaolin Li
  • Xiangjiao Meng
  • Xianguang Zhao
  • Ligang XingEmail author
  • Jinming Yu


Radiation-induced oral mucositis has a dismal outcome with limited treatment options. We conducted a phase I study to evaluate the safety and preliminary efficacy of epigallocatechin-3-gallate (EGCG) mouthwash when given along with radiation in head and neck cancer. Patients with pathologically confirmed head and neck cancer were eligible for this study. EGCG mouthwash was administered at the assigned dosage level (starting at 440 μmol/L, three times a day) in a standard 3 + 3 dose escalation design. Mucosal toxicity, patient satisfaction, and mucositis-related pain (MTP) were assessed weekly. The primary endpoint was safety of EGCG, and the secondary endpoint was to determine the relief of the mucositis symptom. The pre- and post-treatment parameters were compared using the paired t-test. 20 patients were enrolled. The maximum tolerated dose of the EGCG mouthwash was 2200 μmol/L. Burning (n = 1/20) and nausea (n = 3/20) were the most common toxicities. No patients experienced WHO Grade 3 or higher mucositis. MTP scores significantly decreased after EGCG administration over time (p < 0.05). Adding EGCG mouthwash to radiotherapy is feasible without increasing toxicities. The recommended dose for phase II study is determined to be 1760 μmol/L, and EGCG administration reduces radiation-induced oral mucosal injury in patients.


Head and neck neoplasms Epigallocatechin-3-gallate Mucositis, radiation-induced 



The work was supported by National Natural Science Foundation of China (81572970), Shandong Provincial Natural Science Foundation (No. ZR2016HM35) and the grants from Shandong Provincial key scientific and technological project of China (2018GSF118232; 2018GSF118110).

Compliance with ethical standards

Conflict of interest

WZ declares that he has no conflict of interest. HM declares that he has no conflict of interest. LJ declares that he has no conflict of interest. HZ declares that he has no conflict of interest. XL declares that he has no conflict of interest. XM declares that he has no conflict of interest. XZ declares that he has no conflict of interest. LX declares that he has no conflict of interest. JY declares that he has no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Wanqi Zhu
    • 1
  • Hui Mei
    • 2
  • Li Jia
    • 3
  • Hanxi Zhao
    • 2
    • 4
    Email author
  • Xiaolin Li
    • 2
  • Xiangjiao Meng
    • 2
  • Xianguang Zhao
    • 2
  • Ligang Xing
    • 2
    • 4
    Email author
  • Jinming Yu
    • 1
  1. 1.Tianjin Medical University, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
  2. 2.Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina
  3. 3.Jinan Fourth People’s HospitalJinanChina
  4. 4.Department of Radiation Oncology, Shandong Cancer Hospital and InstituteShandong First Medical University and Shandong Academy of Medical SciencesJinanChina

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