R E V I E W Oral mucositis induced by anticancer treatments: physiopatholog y and treatments D’Hondt, Lionel Lonchay, Christophe André, Marc Canon, Jean-Luc Centre Hospitalier Notre-Dame et Reine Fabiola, Charleroi, Belgium Correspondence: Lionel D’Hondt Department of Hematology and Oncology, Centre Hospitalier Notre- Dame et Reine Fabiola, Grand’Rue 3, 6000 Charleroi, Belgium Tel +32 71 28 16 66 Fax +32 71 28 16 73 Email dhondt.lionel@chndrf.be Abstract: Oral mucositis is a frequent and devastating side effect of anticancer treatments. It impairs the patient’s quality of life and also can be life threatening because severe infections and delayed or incomplete anticancer treatments may result. This problem has been largely overlooked and underestimated in the past. However, recently studies have been performed to precisely identify the epidemiology, cost, consequences, physiopathology, and treatments of oral mucositis. Clinical guidelines have recently been published to help the daily management of this frequent complication. In addition, some innovative new drugs, including palifermin, have been developed to prevent and treat this major side effect of cancer treatments. In this paper we summarize the recent developments of oral mucositis management. Keywords: chemotherapy, radiotherapy, oral mucositis, palifermin Introduction Anticancer treatment-related mucosal damage to the oral cavity is referred to as oral mucositis, and until recently it has been underestimated and overlooked (Wright et al 2005). Treatments of this important side effect have likely been suboptimal and based on assumptions rather than evidence. In addition, physiopathologic aspects have not been addressed. Fortunately, this important issue has received greater attention in recent years because oral mucositis not only has a dramatic impact on the patient’s quality of life, but it also can adversely influence the administration of an optimal antineoplasic treatment. Frequently, dose reductions, treatment delays, or discontinuations are necessary to allow the oral lesions to heal. In addition, life- threatening infections and higher treatment costs are clearly related to the severity of oral mucositis. Additional days of total parenteral nutrition, use of narcotic analgesics, total hospital charges, and 100-day mortality are also linked to the severity of mucositis (Rubenstein et al 2004). Important epidemiologic studies have been conducted in an attempt to isolate risk factors and a great deal of basic research has advanced our understanding of the mechanisms underlying oral mucositis. Taken together, these findings have provided the basis for the development of new target therapies. Recently there have been efforts to summarize knowledge acquired in the treatment of stomatitis. A critical review of the literature allowed a panel of experts to propose clinical practice guidelines for the prevention and treatment of this complication (Rubenstein et al 2004; Sonis et al 2004). This panel of experts from the Multinational Association of Supportive Care and the International Society for Oral Oncology (MASSC/ISOO) formed the Mucositis Study Section. In this paper, we will focus on anticancer-induced oral mucositis, detailing the physiopathology and the treatment of this devastating complication. We will particularly emphasize the emerging role of palifermin (recombinant human keratinocyte growth factor), the first US Food and Drug Administration (FDA)-approved target therapy for oral mucositis. Therapeutics and Clinical Risk Management 2006:2(2) 159–168 © 2006 Dove Medical Press Limited. All rights reserved 159