The MASCC/ISOO Mucositis Guidelines: dissemination and clinical impact

This editorial introduces the second set of articles related to the update of the clinical practice guidelines for mucositis, developed by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO)

Mondklachten: bijwerkingen van nieuwe, doelgerichte kankertherapieën

Het aantal nieuwe, ‘doelgerichte’middelen voor de behandeling van kanker breidt zich snel uit en deze middelen nemen een steeds prominentere plaats in bij de behandeling van verschillende soorten kanker. Patiënten wordenmeestal ambulant en gedurende een langere periode (maanden tot jaren) behandeld. Ook de tandarts-algemeen practicus zal deze patiënten in de stoel krijgen. Veel van dezemiddelen gevenmondklachten. De prevalentie verschilt sterk permiddel en varieert van 0 tot 52%. Patiënten kunnen hinderlijke gevoeligheid en ulceraties van de orale slijmvliezen ontwikkelen, de sensibiliteit van gebitselementen is soms verhoogd en veelvuldig doen zich klachten over een droge mond en smaakveranderingen voor. Dit kan leiden tot het noodgedwongen aanpassen van de dosis, het onderbreken of het definitief beëindigen van de oncologische therapie. Tevens zijn er bijwerkingen die relevant zijn wanneer invasieve tandheelkundige ingrepen gepland zijn. Zo hebben angiogeneseremmers een effect op de bloedingsneiging en de wondgenezing. Ook is er casuïstiek van kaakbotnecrose ten gevolge van dezemiddelen beschreven. Dit artikel beoogt de tandarts te informeren over de orale bijwerkingen van een aantal doelgerichte kankertherapieën en aanwijzingen te geven voor de praktijk

Prevention and management of adverse events related to regorafenib

Experimentele farmacotherapi

Risk of oral and gastrointestinal mucosal injury among patients receiving selected targeted agents: a meta-analysis

Purpose The purpose of this study was to estimate the risk and severity of oral and gastrointestinal mucosal toxicities associated with selected targeted agents. Methods We searched the English-language literature in February 2011 for reports of randomized clinical trials comparing a FDA-approved targeted agent to a standard of care regimens. Long-term follow-up and secondary reports of trials were excluded, leaving 85 studies for analysis. Using meta-analytic methods, we calculated the relative risks of oral and gastrointestinal toxicities, adjusting for sample size using the inverse variance technique. For each targeted agent and each side effect, we calculated the number needed to harm, the number of patients that, if treated with the more toxic regimen, would produce one additional episode of the toxicity. Results Oral mucositis was significantly more frequent among patients treated with bevacizumab, erlotinib, sorafenib, or sunitinib, although this difference was confined to low-grade mucositis. The clinical significance of these findings is unclear given its low incidence and mild severity. In contrast, diarrhea was significantly more frequent with most of the targeted agents studied, with adjusted relative risks between 1.5 and 4.5. An additional patient with diarrhea will be observed for every three to five patients treated with these targeted agents, compared with conventional regimens. Conclusions Oral mucosal toxicities occasionally complicate treatment with these targeted agents, but the clinical significance of this finding is not clear. Diarrhea is a hallmark of treatment with these targeted agents; this side effect should be carefully ascertained to permit early intervention and control

Prospective practice survey of management of cetuximab-related skin reactions

Purpose Evidence-based guidelines on how to prevent or treat cetuximab-related skin reactions are lacking and multiple care and management strategies are used. The main purpose of the present study is to gain information about the different skincare products being used against skin reactions in metastatic colorectal cancer (mCRC) and recurrent/metastatic (R/M) or locally advanced (LA) squamous cell cancer of the head and neck (SCCHN) patients treated with cetuximab. Methods An open-label, prospective observational study conducted in the Netherlands. The occurrence of skin reactions and the care and management options taken were documented for 16 weeks, starting from the first administration of cetuximab. Results A total of 103 patients were included in 7 hospitals. 38 patients (37%) developed a grade >= 2 skin reaction. Eighty-six patients could be analysed for the primary endpoint (73.3% males, mean age 62.4 years, n = 44 LA SCCHN, n = 16 R/M SCCHN, n = 26 mCRC). The most frequently used skin products at some point during the observation period were moisturizing products (70%), systemic antibiotics (64%), topical antibiotics (58%), lipid-regenerating (28%) and other topical products (28%). The overall use of products gradually increased from baseline to week 6-10, reducing by week 16. Hospital protocols were the primary reason (> 50%) for choice of the skincare products and medications. Conclusion A variety of skin care products and antibiotics were commonly used. Only few patients developed severe cutaneous reactions. For patients, the occurrence of skin reactions did not influence their willingness to continue cetuximab therapy.Experimentele farmacotherapi

Prospective practice survey of management of cetuximab-related skin reactions

PURPOSE: Evidence-based guidelines on how to prevent or treat cetuximab-related skin reactions are lacking and multiple care and management strategies are used. The main purpose of the present study is to gain information about the different skincare products being used against skin reactions in metastatic colorectal cancer (mCRC) and recurrent/metastatic (R/M) or locally advanced (LA) squamous cell cancer of the head and neck (SCCHN) patients treated with cetuximab. METHODS: An open-label, prospective observational study conducted in the Netherlands. The occurrence of skin reactions and the care and management options taken were documented for 16 weeks, starting from the first administration of cetuximab. RESULTS: A total of 103 patients were included in 7 hospitals. 38 patients (37%) developed a grade ≥ 2 skin reaction. Eighty-six patients could be analysed for the primary endpoint (73.3% males, mean age 62.4 years, n = 44 LA SCCHN, n = 16 R/M SCCHN, n = 26 mCRC). The most frequently used skin products at some point during the observation period were moisturizing products (70%), systemic antibiotics (64%), topical antibiotics (58%), lipid-regenerating (28%) and other topical products (28%). The overall use of products gradually increased from baseline to week 6-10, reducing by week 16. Hospital protocols were the primary reason (> 50%) for choice of the skincare products and medications. CONCLUSION: A variety of skin care products and antibiotics were commonly used. Only few patients developed severe cutaneous reactions. For patients, the occurrence of skin reactions did not influence their willingness to continue cetuximab therapy