Latest Developments

Recent descriptions of the biological processes involved in developing oral mucositis (OM) have greatly expanded scientific understanding of the disease.1 While OM is a much more complex disease than was thought previously, this complexity offers many new opportunities for preventing and treating it by targeting some of the many biological pathways in its development process.2

Many new therapies under investigation mechanically modify biological processes. Some target specific processes such as inflammation, reactive oxygen species (ROS) production or mucosal growth. Others are designed to intervene and counteract the process of mucosal damage.3

Amifostine is a free-radical scavenger that reduces inflammation cycles. L-glutamine is being developed to help prevent mucosal damage during treatment.3 Palifermin (keratinocyte growth factor) was approved in December, 2004, for a limited group of patients with hematologic malignancies who have severe OM and are receiving hematopoietic stem-cell transplantation.4

The challenge for all therapies will be to achieve the protection or targeting of healthy tissue without compromising the power of chemotherapeutic drugs to kill tumors.3

Future treatment strategies will most likely involve combining these new therapies with each other and with other known agents. For instance, combining anti-inflammatory therapies with those that inhibit OM development may prove viable.2

One of the problems facing oncologists today is that it is difficult to predict how a patient will react to a therapy.2 Consequently, studies of genetic factors are underway that may someday improve outcomes by providing pretreatment genetic risk factor analyses. Related studies also are underway to develop gene therapy approaches for preventing mucositis.3