Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Jun 20;11(6):857.
doi: 10.3390/cancers11060857.

Mucosal Injury during Anti-Cancer Treatment: From Pathobiology to Bedside

Debora Basile  1   2 , Paola Di Nardo  3 , Carla Corvaja  4   5 , Silvio Ken Garattini  6   7 , Giacomo Pelizzari  8   9 , Camilla Lisanti  10   11 , Lucia Bortot  12   13 , Lucia Da Ros  14 , Michele Bartoletti  15   16 , Matteo Borghi  17 , Lorenzo Gerratana  18   19 , Davide Lombardi  20 , Fabio Puglisi  21   22
Affiliations
Review

Mucosal Injury during Anti-Cancer Treatment: From Pathobiology to Bedside

Debora Basile et al. Cancers (Basel). .

Abstract

Mucositis is one of the most common debilitating side effects related to chemotherapy (CT), radiation therapy (RT), targeted agents and immunotherapy. It is a complex process potentially involving any portion of the gastrointestinal tract and injuring the mucosa, leading to inflammatory or ulcerative lesions. Mechanisms and clinical presentation can differ according both to the anatomic site involved (oral or gastrointestinal) and the treatment received. Understanding the pathophysiology and management of mucosal injury as a secondary effect of anti-cancer treatment is an important area of clinical research. Prophylaxis, early diagnosis, and adequate management of complications are essential to increase therapeutic success and, thus, improve the survival outcomes of cancer patients. This review focuses on the pathobiology and management guidelines for mucositis, a secondary effect of old and new anti-cancer treatments, highlighting recent advances in prevention and discussing future research options.

Keywords: anti-cancer treatments; mucosal impairment; mucosal injury; mucositis.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Mucositis pathobiology. This model has proven relevant for oral mucositis and gastrointestinal mucositis induced by chemotherapy and radiotherapy [7,13]. Conversely, there is still little information about the pathogenesis of mucositis associated with the newer anticancer treatment, but they likely differ from “classical mucositis”.
Figure 2
Figure 2
Dose modifications and management of mTOR inhibitors.
Figure 3
Figure 3
Dose modifications and management of CDK4/6 inhibitors.
Figure 4
Figure 4
Dose modifications and management of immunotherapy.
See this image and copyright information in PMC

References

    1. Pico J.-L., Avila-Garavito A., Naccache P. Mucositis: Its occurrence, consequences, and treatment in the oncology setting. Oncologist. 1998;3:446–451. - PubMed
    1. Bensinger W., Schubert M., Ang K.K., Brizel D., Brown E., Eilers J.G., Elting L., Mittal B.B., Schattner M.A., Speilberg R., et al. NCCN Task Force Report—Prevention and management of mucositis in cancer care. J. Natl. Compr. Cancer Netw. 2008;6:S1–S21. - PubMed
    1. Sonis S.T., Elting L.S., Keefe D., Peterson D.E., Schubert M., Hauer-Jensen M., Bekele B.N., Raber-Durlacher J., Donnelly J.P., Rubenstein E.B., et al. Perspectives on cancer therapy-induced mucosal injury: Pathogenesis, measurement, epidemiology, and consequences for patients. Cancer. 2004;100:1995–2025. doi: 10.1002/cncr.20162. - DOI - PubMed
    1. Mortensen H.R., Overgaard J., Specht L., Overgaard M., Johansen J., Evensen J.F., Andersen L.J., Andersen E., Grau C. Prevalence and peak incidence of acute and late normal tissue morbidity in the DAHANCA 6&7 randomised trial with accelerated radiotherapy for head and neck cancer. Radiother. Oncol. J. Eur. Soc. Ther. Radiol. Oncol. 2012;103:69–75. - PubMed
    1. Blijlevens N., Schwenkglenks M., Bacon P., D’Addio A., Einsele H., Maertens J., Niederwieser D., Rabitsch W., Roosaar A., Ruutu T., et al. Prospective oral mucositis audit: Oral mucositis in patients receiving high-dose melphalan or BEAM conditioning chemotherapy--European Blood and Marrow Transplantation Mucositis Advisory Group. J. Clin. Oncol. 2008;26:1519–1525. doi: 10.1200/JCO.2007.13.6028. - DOI - PubMed

LinkOut - more resources