Researchers from Denmark have reported that chlorhexidine mouth washes or oral cooling decreases the incidence and severity of oral mucositis associated with 5 FU and leucovorin-based chemotherapy for gastrointestinal cancer. The details of this randomized study appeared in an early online publication in Cancer on February 15, 2008.¹

Mucositis is a well known complication of high-dose therapy and treatment of almost all cases of leukemias. Severe mucositis is also reported in 37% of patients with solid tumors or lymphomas receiving conventional doses of chemotherapy. Mucositis leads to increased hospitalization and increased costs. Methods to decrease the incidence and severity of mucositis would have major clinical and economic benefits. Keritonocyte growth factor (Kepivance®) has been approved for prevention of mucositis in patients undergoing autologous stem cell transplantation. Other methods of treating or preventing oral mucositis include oral antiseptics, cryotherapy, laser therapy, L-glutamine, and velafermin. Previous studies of antiseptic, antibiotic, and antifungal mouth washes and lozenges have revealed no dramatic effects but also no definitive conclusions. Two randomized trials published in the British Journal of Cancer and the Journal of Hospital Infection have suggested a limited role for topical antibiotic and antifungal treatment of mucositis (see last item of related news).

The current study randomly allocated 225 patients treated with 5-FU-based chemotherapy to receive chlorhexidine mouth washes, cryotherapy, or saline mouth washes. Grade 3-4 mucositis occurred in 33% of control patients, 13% of patients receiving chlorhexidine, and 11% of patients receiving cryotherapy. Both therapy groups had a shorter duration of mucositis than the control group. These authors concluded that chlorhexidine should be explored further for the prevention of mucositis.

Comments: The results of cryotherapy are similar to those previously reported. However, the chlorhexidine results are at odds with some other randomized trials. In one trial chlorhexidine actually made mucositis worse (see last item of related news) compared with saline. The main problem with this study was that it was based on patient self-reporting, a technique that has not been as reliable as independent assessment by a skilled observer.

Related News:

Kepivance® May Decrease Oral Mucositis Following High-Dose Chemotherapy (1/8/2007)

Kepivance® Decreases Oral Mucositis in Patients with Metastatic Colorectal Cancer. (11/27/2006)

Daily Low Power Laser Therapy May Prevent Oral Mucositis in Stem Cell Transplant Patients (10/25/2006)

L-Glutamine Effective in Prevention of Oral Mucositis After Chemoradiotherapy for Head and Neck Cancer (8/6/2006)

Oral Cryotherapy Prevents Mucositis From High-Dose Alkeran® (6/1/2006)

Kepivance™ Improves Patient-Assessed Oral Mucositis Following Autologous Stem Cell Transplantation (4/21/2006)

Velafermin May Decrease Oral Mucositis after Autologous Transplantation (3/2/2006)

Oral and Gastrointestinal Chemotherapy Induced Mucositis Causes Significant Clinical Problems and Increases the Costs of Treatment (9/24/2003)

Topical Antiseptic or Antibiotic and Antifungal Treatments Have Little Effect on Mucositis (4/22/2003)

Reference:

¹ Sorensen JB, Skovsgaard T, Bork E, et al. Double-blind, placebo-controlled randomized study of chlorhexidine prophylaxis for 5-flurouracil-based chemotherapy-induced oral mucositis with nonblinded randomized comparison to oral cooling (cryotherapy) in gastrointestinal malignancies. Cancer [early online publication] February 25, 2008.