title: Phenylbutyrate mouthwash mitigates oral mucositis during radiotherapy or chemoradiotherapy in patients with head-and-neck cancer.
abstract: OBJECTIVE
  Deleterious oral mucositis (OM) develops during radiotherapy (RT) or chemoradiotherapy for head-and-neck cancer (HNC) patients. There are currently no effective cytoprotective treatments for OM without a potential risk of tumor protection. This randomized, double-blind, placebo-controlled pilot study aimed to determine the therapeutic safety and efficacy of phenylbutyrate (an antitumor histone deacetylase inhibitor and chemical chaperone) 5% mouthwash for treating OM caused by cancer therapy.
  
  
  METHODS
  Between September 2005 and June 2006, 36 HNC patients were randomized to standard oral care plus 5 mL of either phenylbutyrate 5% mouthwash (n = 17) or placebo (mouthwash vehicle, n = 19) taken four times daily (swish and spit). Treatment began when mild mucositis (Radiation Therapy Oncology Group Grade 1) occurred, and ended 4 weeks after RT completion. Safety and efficacy were based on adverse events, physical examination, laboratory determinations, vital signs, Oral Mucosa Assessment Scale (OMAS) and World Health Organization scores, the ability to eat, body weight change, local control, and survival.
  
  
  RESULTS
  We found no severe drug-related side effect. At RT doses of 5500-7500 cGy, phenylbutyrate significantly mitigated the severity of mucositis compared with placebo, based on both the WHO score (severity ≥ 3; p = 0.0262) and the OMAS scale (ulceration score ≥ 2; p = 0.0049). The Kaplan-Meier estimates for 2- and 3-year local control, and overall survival were 100% and 80.8%, and 78.6% and 64.3%, respectively, in the phenylbutyrate group and 74.2% and 74.2%, and 57.4% and 50.2%, respectively, in the placebo group.
  
  
  CONCLUSIONS
  This pilot trial suggested that phenylbutyrate mouthwash significantly decreased the impact of OM in HNC patients receiving RT or chemoradiotherapy and did not confront the tumor control. Larger Phase II randomized trials are needed to confirm these results.
authors.affiliation: Cancer Center, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Sang-Hue
authors.initials: SH
authors.lastname: Yen
authors.forename: Ling-Wei
authors.initials: LW
authors.lastname: Wang
authors.forename: Yi-Hsien
authors.initials: YH
authors.lastname: Lin
authors.forename: Yee-Min
authors.initials: YM
authors.lastname: Jen
authors.forename: Yih-Lin
authors.initials: YL
authors.lastname: Chung
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D059248:Chemoradiotherapy / Q000009:adverse effects / Q000379:methods; D002945:Cisplatin / Q000008:administration & dosage; D004311:Double-Blind Method; D004435:Eating; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D056572:Histone Deacetylase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016685:Mitomycin / Q000008:administration & dosage; D009067:Mouthwashes / Q000009:adverse effects / Q000627:therapeutic use*; D010654:Phenylbutyrates / Q000009:adverse effects / Q000627:therapeutic use*; D010865:Pilot Projects; D011832:Radiation Injuries / Q000188:drug therapy* / Q000209:etiology; D011879:Radiotherapy Dosage; D013280:Stomatitis / Q000188:drug therapy* / Q000209:etiology; D013624:Taiwan; D005641:Tegafur / Q000008:administration & dosage; D014498:Uracil / Q000008:administration & dosage; D015431:Weight Loss
chemical_list: D056572:Histone Deacetylase Inhibitors; D009067:Mouthwashes; D010654:Phenylbutyrates; D005641:Tegafur; D016685:Mitomycin; D014498:Uracil; D002945:Cisplatin; D005472:Fluorouracil