Systematic review of agents for the management of cancer treatment-related gastrointestinal mucositis and clinical practice guidelines
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The aim of this study was to update the clinical practice guidelines for the use of agents for the prevention and/or treatment of gastrointestinal mucositis (GIM).
A systematic review was conducted by the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society for Oral Oncology (MASCC/ISOO). The body of evidence for each intervention, in each cancer treatment setting, was assigned an evidence level. Based on the evidence level, one of the following three guideline determinations was possible: Recommendation, Suggestion, and No Guideline Possible.
A total of 78 papers across 13 interventions were examined of which 25 were included in the final review. No new guidelines were possible for any agent due to inadequate and/or conflicting evidence. Existing guidelines for probiotics and hyperbaric oxygen were unchanged.
Of the agents studied for the prevention and treatment of GIM, the evidence continues to support use of probiotics containing Lactobacillus spp. for prevention of chemoradiotherapy and radiotherapy-induced diarrhea in patients with pelvic malignancy, and hyperbaric oxygen therapy to treat radiation-induced proctitis. Additional well-designed research is encouraged to enable a decision regarding palifermin, glutamine, sodium butyrate, and dietary interventions, for the prevention or treatment of GIM.
KeywordsMucositis Guidelines Clinical management Gastrointestinal
We would like to acknowledge the expert assistance of our research librarians during the development of the database search terms and paper retrieval; Lorraine Porcello (Bibby Dental Library, Eastman Institute for Oral Health, University of Rochester Medical Center, Rochester, NY, USA) and Daniel A. Castillo (Edward G. Miner Library, University of Rochester Medical Center, Rochester, NY, USA). On behalf of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO).
Compliance with ethical standards
Conflict of interest
These authors disclose no relevant conflict of interest: JC, NB, NA, EB, KC, CDM, BM, AS, WT, HW, YVS, VR, AV, KKFC, SE. JB and RG are MASCC board members.
PB has served an advisory role for AstraZeneca, Helsinn, and Kyowa Kyrin and received grants from Merck, Kyowa Kyrin, and Roche. DK is on the advisor board for Zealand Pharma and Helsinn, the speakers bureau for Merck and Mundipharma, and a consultant for Entrinsic Health Solutions.
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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