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Otorhinolaryngological Toxicities of New Drugs in Oncology

Abstract

Many new or relatively new cancer drugs—personalized anticancer agents—have been approved for use in various clinical settings in oncology or are still under evaluation in clinical trials. Targeted therapies as well as new immune checkpoint blockers have toxicity profiles that differ from conventional cytotoxic chemotherapy, and many can cause adverse effects that affect the mouth and pharynx, the nasal cavities, and the larynx. This review aims to provide an overview of current knowledge concerning these side effects and contemporary management. Adverse effects of the mouth/pharynx, nasal cavities, larynx, and cochlear-vestibular system are generally low grade (according to the Common Terminology Criteria for Adverse Events) and generally present non-life-threatening symptoms. However, the impact on patients’ quality of life could be important. The incidence and severity vary according to the drug, its target(s), and dose, but there are currently no known predictive factors, and each patient has an individual toxicity profile. Management guidelines are based on expert opinion. These ear, nose, and throat adverse effects are not frequently mentioned in the literature because of the often non-specific nature of the symptoms and their mildness, but also the absence of specific treatment. These symptoms can contribute to decreased quality of life and lead to drug compliance issues if not diagnosed and managed appropriately.

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Abbreviations

Ab:

Antibodies

ALK:

Anaplastic Lymphoma Kinase

AXL:

AXL receptor tyrosine kinase

BRAF:

B-raf proto-oncogene, serine/threonine kinase

CRAF:

RAF proto-oncogene serine/threonine-protein kinase

CTCAE:

Common Terminology Criteria for Adverse Events

CTLA-4:

Cytotoxic T-lymphocyte associated protein 4

EGF:

Epidermal growth factor

EGFR:

Epidermal growth gactor receptor

ENT:

Ear, nose and throat

FLT3:

Fms Related tyrosine kinase 3

FGFR:

Fibroblast growth factor receptor

HER:

Human epidermal growth factor receptor

ICB:

Immune checkpoint blockade

KIT:

KIT Proto-oncogene receptor tyrosine kinase

MAPK:

Mitogen-Activated Protein Kinases

MET:

MET proto-oncogene, receptor tyrosine kinase

mIAS:

mTOR inhibitor-associated stomatitis

MROJN:

Medication–related osteonecrosis of the jaw

mTOR:

Mammalian target of rapamycin

PKI:

Protein kinase inhibitor

PARP:

Poly (ADP-ribose) polymerase

PDGF:

Platelet-derived growth factor

PDGFR:

Platelet-derived growth factor receptor

PD-1:

Programmed cell death 1

PD-L1:

Programmed cell death ligand 1

PI3K:

Phosphatidylinositol-4,5-bisphosphate 3-kinase

PIGF:

Phosphatidylinositol glycan anchor biosynthesis class F

RET:

REarranged during transfection

TKI:

Tyrosine kinase inhibitor

VEGF:

Vascular endothelial growth factor

VEGFR:

Vascular endothelial growth factor receptor

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Acknowledgements

This article was written by members and invitees of the International Head and Neck Scientific Group (www.IHNSG.com).

No funding or sponsorship was received for this study or publication of this article. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval for the version to be published.

Disclosures

Dana M. Hartl, Daphné Morel, Erika Saavedra, Christophe Massard, Alessandra Rinaldo, Nabil F. Saba, Alfio Ferlito, and J.C. Soria have nothing to disclose.

Compliance with Ethics Guidelines

This article is based on previously conducted studies and does not involve any new studies of human or animal subjects performed by any of the authors.

Data Availability

Data sharing is not applicable to this article as no datasets were generated or analyzed during the current study.

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Correspondence to Dana M. Hartl.

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Hartl, D.M., Morel, D., Saavedra, E. et al. Otorhinolaryngological Toxicities of New Drugs in Oncology. Adv Ther 34, 866–894 (2017). https://doi.org/10.1007/s12325-017-0512-0

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  • DOI: https://doi.org/10.1007/s12325-017-0512-0

Keywords

  • Mucositis
  • Oncology
  • Protein kinase inhibitors
  • Small molecule inhibitors