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

  • Anura AriyawardanaEmail author
  • Karis Kin Fong Cheng
  • Abhishek Kandwal
  • Vanessa Tilly
  • Abdul Rahman Al-Azri
  • Dimitra Galiti
  • Karen Chiang
  • Anusha Vaddi
  • Vinisha Ranna
  • Ourania Nicolatou-Galitis
  • Rajesh V. Lalla
  • Paolo Bossi
  • Sharon Elad
  • On behalf of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO)
Special Article



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.


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.


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.


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.


Oral mucositis Cancer Management Anti-inflammatory agents Intervention Guidelines Radiotherapy Chemotherapy 



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.

Compliance with ethical standards

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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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Anura Ariyawardana
    • 1
    • 2
    Email author
  • Karis Kin Fong Cheng
    • 3
  • Abhishek Kandwal
    • 4
  • Vanessa Tilly
    • 5
  • Abdul Rahman Al-Azri
    • 6
  • Dimitra Galiti
    • 7
  • Karen Chiang
    • 8
  • Anusha Vaddi
    • 9
  • Vinisha Ranna
    • 10
  • Ourania Nicolatou-Galitis
    • 7
  • Rajesh V. Lalla
    • 11
  • Paolo Bossi
    • 12
  • Sharon Elad
    • 9
  • On behalf of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO)
  1. 1.College of Medicine and DentistryJames Cook UniversityCairnsAustralia
  2. 2.Metro South Oral HealthBrisbaneAustralia
  3. 3.Alice Lee Centre for Nursing Studies, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore
  4. 4.Department of Dental Surgery, Cancer Research Institute, Himalayan Institute of Medical SciencesSwami Rama Himalayn UniversityDehradunIndia
  5. 5.Dental Oncology Service, Instituto do Câncer do Estado de São PauloFaculdade de Medicina da Universidade de São PauloSão PauloBrazil
  6. 6.Dental and OMFS Department, Oral Pathology and Medicine, Al-Nahdha HospitalMinistry of HealthMuscatOman
  7. 7.Dental SchoolNational and Kapodistrian University of AthensAthensGreece
  8. 8.Pharmacy DepartmentSt. Vincent’s Hospital MelbourneFitzroyAustralia
  9. 9.Oral Medicine, Eastman Institute for Oral HealthUniversity of Rochester Medical CenterRochesterUSA
  10. 10.Department of Oral and Maxillofacial SurgeryThe Mount Sinai HospitalNew YorkUSA
  11. 11.Section of Oral MedicineUniversity of Connecticut School of Dental MedicineFarmingtonUSA
  12. 12.Department of Medical and Surgical Specialties, Radiological Sciences and Public Health-Medical Oncology, ASST-Spedali CiviliUniversity of BresciaBresciaItaly

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