Abstract
Dose-limiting toxicities are ubiquitous to cancer-directed therapy, presenting with severity to a degree that necessitates therapy de-escalation, pause, or discontinuation. To date, there is incredible limited understanding if these therapy de-escalations present risk for survival by limiting delivery of intensive therapy, or if they indicate physiologic susceptibility and are a favorable prognostic indicator. Mucositis is an excellent illustration of the current paradox of dose-limiting toxicities—it has existed alongside therapy for eight decades, but despite its presence, there is an incomplete understanding of how it develops, why it varies between oncologic populations, and if it relates to cancer survival. Rigorous methodologic approaches in symptom science holds potential to better understand mucositis, to determine if it is a marker of response or threat, and evaluate if it holds potential to guide therapy delivery.
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References
Collins M, Wilhelm M, Conyers R et al (2013) Benefits and adverse events in younger versus older patients receiving neoadjuvant chemotherapy for osteosarcoma: findings from a meta-analysis. J Clin Oncol 31(18):2303–2312. https://doi.org/10.1200/jco.2012.43.8598
Fanning SR, Rybicki L, Kalaycio M et al (2006) Severe mucositis is associated with reduced survival after autologous stem cell transplantation for lymphoid malignancies. Br J Haematol 135(3):374–381. https://doi.org/10.1111/j.1365-2141.2006.06323.x
Nageswara Rao AA, Wallace DJ, Billups C, Boyett JM, Gajjar A, Packer RJ (2014) Cumulative cisplatin dose is not associated with event-free or overall survival in children with newly diagnosed average-risk medulloblastoma treated with cisplatin based adjuvant chemotherapy: report from the Children’s Oncology Group. Pediatr Blood Cancer 61(1):102–106. https://doi.org/10.1002/pbc.24670
McTiernan A, Jinks RC, Sydes MR et al (2012) Presence of chemotherapy-induced toxicity predicts improved survival in patients with localised extremity osteosarcoma treated with doxorubicin and cisplatin: a report from the European Osteosarcoma Intergroup. Eur J Cancer 48(5):703–712. https://doi.org/10.1016/j.ejca.2011.09.012
Wong HH, Halford S (2015) Dose-limiting toxicity and maximum tolerated dose: still fit for purpose? Lancet Oncol 16(13):1287–1288. https://doi.org/10.1016/S1470-2045(15)00248-X
Fraisse J, Dinart D, Tosi D, Bellera C, Mollevi C (2021) Optimal biological dose: a systematic review in cancer phase I clinical trials. BMC Cancer 21(1):60. https://doi.org/10.1186/s12885-021-07782-z
Miller TP, Marx MZ, Henchen C et al (2022) Challenges and barriers to adverse event reporting in clinical trials: a Children’s Oncology Group report. J Patient Saf 18(3):e672–e679. https://doi.org/10.1097/pts.0000000000000911
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Dr. Thornton and Dr. Orgel devised the topic of this work and both equally contributed to the writing of this manuscript. Both authors have reviewed the manuscript.
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Thornton, C.P., Orgel, E. Dose-limiting mucositis: friend or foe?. Support Care Cancer 31, 617 (2023). https://doi.org/10.1007/s00520-023-08101-x
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DOI: https://doi.org/10.1007/s00520-023-08101-x