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

Debora Basile, Paola Di Nardo, Carla Corvaja, Silvio Ken Garattini, Giacomo Pelizzari, Camilla Lisanti, Lucia Bortot, Lucia Da Ros, Michele Bartoletti, Matteo Borghi, Lorenzo Gerratana, Davide Lombardi, Fabio Puglisi, Debora Basile, Paola Di Nardo, Carla Corvaja, Silvio Ken Garattini, Giacomo Pelizzari, Camilla Lisanti, Lucia Bortot, Lucia Da Ros, Michele Bartoletti, Matteo Borghi, Lorenzo Gerratana, Davide Lombardi, Fabio Puglisi

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.

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.

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