Epidemiology of treatment-associated mucosal injury after treatment with newer regimens for lymphoma, breast, lung, or colorectal cancer.
OBJECTIVE
Oral and gastrointestinal (GI) mucositis are frequent complications of chemotherapy and radiotherapy for cancer, contributing to not only the morbidity of treatment but its cost as well. The risk associated with specific chemotherapeutic agents, alone and in combination, has been characterized previously. In the current study, we sought to estimate the risk associated with newer regimens for the treatment of non-Hodgkin's lymphoma (NHL) and common solid tumors.


METHODS
We reviewed published studies reporting phase II and III clinical trials of dose-dense regimens for breast cancer and NHL, TAC (docetaxel, adriamycin, cyclophosphamide) chemotherapy for breast cancer, and infusional 5-fluorouracil-based regimens for colorectal cancer. Platinum-, gemcitabine-, and taxane-based regimens for lung cancer, either alone or in combination with radiotherapy, were also considered. Using modified meta-analysis methods, we calculated quality-adjusted estimates of the risk for oral and GI mucositis by tumor type and regimen. Case reports are used to emphasize the relevance of the findings for patient care.


RESULTS
Our findings demonstrate that mucosal toxicity remains an important complication of cancer treatment. Moreover, innovations in drug combinations, scheduling, or mode of administration significantly modulate the risk for both oral and GI mucositis.


CONCLUSIONS
Ongoing review of the clinical trial experience will remain important as newer, targeted agents enter standard clinical practice.
Jones
Jeffrey A
JA
Section of Health Services Research, Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, USA. jefjones@mdanderson.org
Avritscher
Elenir B C
EB
Cooksley
Catherine D
CD
Michelet
Marisol
M
Bekele
B Nebiyou
BN
Elting
Linda S
LS
D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects; D001943:Breast Neoplasms / Q000188:drug therapy; D002945:Cisplatin / Q000009:adverse effects; D015179:Colorectal Neoplasms / Q000188:drug therapy; D003520:Cyclophosphamide / Q000009:adverse effects; D003841:Deoxycytidine / Q000009:adverse effects / Q000031:analogs & derivatives; D004317:Doxorubicin / Q000009:adverse effects; D005260:Female; D005472:Fluorouracil / Q000009:adverse effects; D005767:Gastrointestinal Diseases / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008175:Lung Neoplasms / Q000188:drug therapy; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy; D052016:Mucositis / Q000453:epidemiology* / Q000209:etiology; D009369:Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000532:radiotherapy; D011241:Prednisone / Q000009:adverse effects; D011878:Radiotherapy / Q000009:adverse effects; D012720:Severity of Illness Index; D013280:Stomatitis / Q000453:epidemiology* / Q000209:etiology; D043823:Taxoids / Q000009:adverse effects; D014747:Vinblastine / Q000009:adverse effects / Q000031:analogs & derivatives; D014750:Vincristine / Q000009:adverse effects; D000077235:Vinorelbine; D000093542:Gemcitabine
D000970:Antineoplastic Agents; D043823:Taxoids; D003841:Deoxycytidine; D014750:Vincristine; D014747:Vinblastine; D004317:Doxorubicin; D003520:Cyclophosphamide; D002945:Cisplatin; D000077235:Vinorelbine; D005472:Fluorouracil; D011241:Prednisone; D000093542:Gemcitabine