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Systematic review of agents for the management of cancer treatment-related gastrointestinal mucositis and clinical practice guidelines

  • Joanne M. BowenEmail author
  • Rachel J. Gibson
  • Janet K. Coller
  • Nicole Blijlevens
  • Paolo Bossi
  • Noor Al-Dasooqi
  • Emma H. Bateman
  • Karen Chiang
  • Charlotte de Mooij
  • Bronwen Mayo
  • Andrea M. Stringer
  • Wim Tissing
  • Hannah R. Wardill
  • Ysabella Z. A. van Sebille
  • Vinisha Ranna
  • Anusha Vaddi
  • Dorothy MK. Keefe
  • Rajesh V. Lalla
  • Karis Kin Fong Cheng
  • Sharon Elad
  • On behalf of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO)
Special Article
  • 26 Downloads

Abstract

Purpose

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).

Methods

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.

Results

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.

Conclusions

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.

Keywords

Mucositis Guidelines Clinical management Gastrointestinal 

Notes

Acknowledgments

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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Copyright information

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

Authors and Affiliations

  • Joanne M. Bowen
    • 1
    Email author
  • Rachel J. Gibson
    • 2
  • Janet K. Coller
    • 1
  • Nicole Blijlevens
    • 3
  • Paolo Bossi
    • 4
  • Noor Al-Dasooqi
    • 1
  • Emma H. Bateman
    • 1
  • Karen Chiang
    • 5
  • Charlotte de Mooij
    • 3
  • Bronwen Mayo
    • 2
  • Andrea M. Stringer
    • 2
  • Wim Tissing
    • 6
  • Hannah R. Wardill
    • 1
  • Ysabella Z. A. van Sebille
    • 2
  • Vinisha Ranna
    • 7
  • Anusha Vaddi
    • 8
  • Dorothy MK. Keefe
    • 1
  • Rajesh V. Lalla
    • 9
  • Karis Kin Fong Cheng
    • 10
  • Sharon Elad
    • 8
  • On behalf of the Mucositis Study Group of the Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO)
  1. 1.Adelaide Medical SchoolUniversity of AdelaideAdelaideAustralia
  2. 2.Division of Health SciencesUniversity of South AustraliaAdelaideAustralia
  3. 3.Radboud University Medical CentreNijmegenThe Netherlands
  4. 4.Department of Medical and Surgical Specialties, Radiological Sciences and Public Health - Medical OncologyUniversity of BresciaBresciaItaly
  5. 5.St Vincent’s HospitalMelbourneAustralia
  6. 6.University Medical Center GroningenUniversity of GroningenGroningenThe Netherlands
  7. 7.Department of Oral and Maxillofacial SurgeryThe Mount Sinai HospitalNew YorkUSA
  8. 8.Oral Medicine, Eastman Institute for Oral HealthUniversity of Rochester Medical CenterRochesterUSA
  9. 9.Section of Oral MedicineUniversity of Connecticut HealthFarmingtonUSA
  10. 10.Alice Lee Centre for Nursing Studies, Yong Loo Lin School of MedicineNational University of SingaporeSingaporeSingapore

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