From the Guidelines
The most effective approach to treating chemotherapy-induced stomatitis is a multi-faceted one, incorporating oral care, pain management, and anti-inflammatory treatments, with a focus on early intervention and individualized care based on the severity of symptoms. This approach is supported by the most recent and highest quality study available, which emphasizes the importance of early intervention and tailored treatment strategies 1.
Key Components of Treatment
- Oral care: Basic oral hygiene using a soft toothbrush and gentle alcohol-free mouthwashes such as 0.9% saline or sodium bicarbonate rinses 4-6 times daily is recommended 1.
- Pain management: Topical anesthetics like 2% viscous lidocaine can provide temporary relief when used as directed before meals 1.
- Anti-inflammatory treatments: Topical corticosteroids such as dexamethasone oral solution (0.5mg/5mL) can reduce inflammation when swished and expectorated 2-4 times daily 1.
- For more severe cases, systemic pain management with NSAIDs or opioids may be necessary, and considerations should be made for delaying treatment until toxicity resolves and potentially lowering the dose of the targeted agent 1.
Additional Considerations
- Mild toothpaste and gentle hygiene are recommended for the treatment of stomatitis 1.
- Consider adding steroid dental paste to treat developing ulcerations 1.
- The use of cryotherapy, low-level laser therapy, and keratinocyte growth factors like palifermin may also be beneficial in specific cases, although these interventions may require specialized care and are supported by earlier evidence 1.
Prioritizing Patient Care
The primary goal in treating chemotherapy-induced stomatitis is to alleviate symptoms, prevent further complications, and improve the patient's quality of life. By adopting a comprehensive and individualized approach to care, healthcare providers can effectively manage this condition and support patients throughout their chemotherapy treatment.
From the FDA Drug Label
The incidence of WHO Grade 3 and 4 in the Kepivance pre-post arm was 38%, compared to 37% in the placebo arm. Median (25 th, 75 thpercentile) Days of WHO Grade 3/4 Oral Mucositis* 3 (0,6) 9 (6,13)
The best way to treat chemotherapy-induced stomatitis is not explicitly stated in the provided drug labels. However, the labels do provide information on the efficacy of Kepivance (palifermin) in reducing the incidence and severity of oral mucositis in patients undergoing chemotherapy.
- Key findings:
- Kepivance reduced the median days of WHO Grade 3/4 oral mucositis from 9 days (placebo) to 3 days.
- The incidence of WHO Grade 3/4 oral mucositis was lower in the Kepivance group (63%) compared to the placebo group (98%).
- Kepivance also reduced the cumulative opioid dose required for pain management. It is essential to note that the labels do not provide a direct comparison of different treatment options for chemotherapy-induced stomatitis, and the efficacy of Kepivance may vary depending on the specific patient population and chemotherapy regimen. Conservative clinical decision: Based on the available data, Kepivance may be considered as a treatment option for reducing the incidence and severity of oral mucositis in patients undergoing chemotherapy, particularly those receiving high-dose cytotoxic therapy. However, the decision to use Kepivance should be made on a case-by-case basis, taking into account the individual patient's risk factors, medical history, and the specific chemotherapy regimen being used 2.
From the Research
Treatment Options for Chemotherapy-Induced Stomatitis
- Various topical solutions have been studied for the treatment of chemotherapy-induced stomatitis, including viscous lidocaine with 1% cocaine, dyclonine hydrochloride 1.0% (Dyclone), kaolin-pectin solution, diphenhydramine plus saline (KBS), and a placebo solution 3.
- Dyclone has been shown to provide the most pain relief, while Dyclone and viscous lidocaine with 1% cocaine provided the longest pain relief, averaging 50 minutes 3.
- A dexamethasone-based mouthwash has been found to safely reduce stomatitis incidence and severity in patients receiving chemotherapy for early breast cancer 4.
- Yarrow distillate has been shown to reduce stomatitis severity in patients with chemotherapy-induced stomatitis 5.
- Other effective treatments for oral mucositis include Dentoxol mouthwashes, Plantago major extract, thyme honey extract, zinc oxide paste, vitamin B complex combined with GeneTime, and the consumption of L-glutamine 6.
- Basic oral care is the most commonly accepted intervention for the prevention or treatment of chemotherapy-induced stomatitis, and loperamide and octreotide have been found to be effective for chemotherapy-induced diarrhea 7.
Comparison of Treatment Options
- The efficacy of different treatment options may vary depending on the individual patient and the specific chemotherapy regimen being used.
- A systematic review of the literature found that various treatment types, including drugs, mouthwashes, medicines based on plant extracts, cryotherapy, and low-intensity laser therapies, have been assessed for the treatment of oral mucositis induced by radiotherapy and/or chemotherapy 6.
- Further research is needed to determine the most effective treatment options for chemotherapy-induced stomatitis and to validate the results of existing studies 4, 6.
Future Directions
- Well-designed trials, preferably including a placebo or no treatment control, are needed to validate more effective interventions for managing chemotherapy-induced mucositis 7.
- The development of new treatment options, such as targeted therapies and gene therapies, may provide additional opportunities for the prevention and treatment of chemotherapy-induced stomatitis.