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Systematic review of anti-inflammatory agents for the management of oral mucositis in cancer patients and clinical practice guidelines

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Abstract

Purpose

The aim of this systematic review was to update the clinical practice guidelines for the use of anti-inflammatory agents in the prevention and/or treatment of oral mucositis.

Methods

A systematic review was conducted by the Multinational Association of Supportive Care in Cancer/ International Society of Oral Oncology (MASCC/ISOO) subcommittee on mucositis guideline update. The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. The findings were added to the database used to develop the clinical practice guidelines published in 2014. Based on the evidence level, one of the following three guideline determinations was possible: recommendation, suggestion, and no guidelines.

Results

A total of 11 new papers across five interventions were examined. The recommendation for the use of benzydamine mouthwash for the prevention of radiotherapy-induced mucositis remained unchanged. New suggestion for the use of the same for prevention of mucositis associated with chemoradiotherapy was made. No guideline was possible for any other anti-inflammatory agents due to inadequate and/or conflicting evidence.

Conclusions

Of the anti-inflammatory agents studied for oral mucositis, the evidence supports the use of benzydamine mouthwash in the specific populations listed above. Additional well-designed research is needed on other (class of agents) interventions and in other cancer treatment settings.

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Acknowledgments

The authors would like to acknowledge the contribution of Lorraine Porcello, MSLIS, MSIM—Bibby Dental Library, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA and Daniel A. Castillo, MLIS—Edward G. Miner Library, University of Rochester Medical Center, Rochester, NY, USA in developing the search language and literature search and help throughout the project.

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Authors and Affiliations

  1. College of Medicine and Dentistry, James Cook University, Cairns, Australia

    Anura Ariyawardana

  2. Metro South Oral Health, Brisbane, Australia

    Anura Ariyawardana

  3. Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Karis Kin Fong Cheng

  4. Department of Dental Surgery, Cancer Research Institute, Himalayan Institute of Medical Sciences, Swami Rama Himalayn University, Dehradun, Uttarakhand, India

    Abhishek Kandwal

  5. Dental Oncology Service, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil

    Vanessa Tilly

  6. Dental and OMFS Department, Oral Pathology and Medicine, Al-Nahdha Hospital, Ministry of Health, Muscat, Oman

    Abdul Rahman Al-Azri

  7. Dental School, National and Kapodistrian University of Athens, Athens, Greece

    Dimitra Galiti & Ourania Nicolatou-Galitis

  8. Pharmacy Department, St. Vincent’s Hospital Melbourne, Fitzroy, Victoria, Australia

    Karen Chiang

  9. Oral Medicine, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA

    Anusha Vaddi & Sharon Elad

  10. Department of Oral and Maxillofacial Surgery, The Mount Sinai Hospital, New York, NY, USA

    Vinisha Ranna

  11. Section of Oral Medicine, University of Connecticut School of Dental Medicine, Farmington, CT, USA

    Rajesh V. Lalla

  12. Department of Medical and Surgical Specialties, Radiological Sciences and Public Health-Medical Oncology, ASST-Spedali Civili, University of Brescia, Brescia, Italy

    Paolo Bossi

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  1. Anura Ariyawardana
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Consortia

On behalf of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO)

Corresponding author

Correspondence to Anura Ariyawardana.

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Conflict of interest

According to the MASCC Guidelines Policy, employees of commercial entities were not eligible to serve on this MASCC Guidelines Panel. The authors disclose no conflict of interest (AA, KKFC, AK, VT, ARAZ, DG, KC, AV, VR, ONG, SE). PB has served an advisory role for AstraZeneca, Helsinn, and Kyowa Kyrin and received grants from Merck, Kyowa Kyrin, and Roche. RVL has served as a consultant for Colgate Oral Pharmaceuticals, Galera Therapeutics, Ingalfarma SA, Monopar Therapeutics, Mundipharma, and Sucampo Pharma; has received research support to his institution from Galera Therapeutics, Novartis, Oragenics, and Sucampo Pharma; and has received stock in Logic Biosciences.

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Ariyawardana, A., Cheng, K.K.F., Kandwal, A. et al. Systematic review of anti-inflammatory agents for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer 27, 3985–3995 (2019). https://doi.org/10.1007/s00520-019-04888-w

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