![]() ![]() 9–12 However, there is currently no recommendation for the prevention of stomatitis in breast cancer patients receiving chemotherapy without multi-agent combination oral care protocols.Įverolimus is an oral mammalian target of rapamycin (mTOR) inhibitor used to treat hormone receptor-positive/human epidermal growth factor receptor 2-negative breast cancer. 2 The Multinational Association of Supportive Care in Cancer (MASCC) MASCC/ISOO Mucositis Guidelines 2019 Update recommends photobiomodulation, parenteral or oral glutamine, and benzydamine mouthwash in patients undergoing haematopoietic stem cell transplantation and patients with head and neck cancer receiving radiotherapy with or without concomitant chemotherapy. 8 However, internal rebamipide showed no efficacy in preventing chemotherapy-induced stomatitis in breast cancer patients. 1 Saforis (glutamine) is reportedly effective for preventing and treating stomatitis in patients with histopathologically confirmed breast cancer receiving anthracycline-based chemotherapy. Oral care protocols are used to prevent stomatitis in all cancer treatment modalities. 6 7 However, recommendations for preventing chemotherapy-induced stomatitis in patients with breast cancer are lacking. 5 Rebamipide is an internal-use mucosal protectant, and gargling with rebamipide has been reported to prevent stomatitis in patients with head and neck cancer who are receiving chemoradiotherapy. Oral cryotherapy prevented stomatitis in patients receiving bolus doses of 5-fluorouracil and haematopoietic stem cell transplantation. 4 Palifermin has therefore been approved by the US Food and Drug Administration and the European Medicines Agency for stomatitis patients with haematological malignancies. Palifermin reduced the duration and severity of stomatitis after intensive chemotherapy and radiotherapy in patients with haematological cancer. Several studies have attempted to prevent chemotherapy-induced stomatitis. Subsequent inflammatory cell infiltrates are associated with mucosal ulceration, and excessive inflammation seems to exacerbate stomatitis. 3 This theory proposes that proinflammatory cytokines, produced mainly by macrophages, injure mucosal cells and activate molecular pathways that amplify mucosal injury. ![]() Lalla et al proposed that stomatitis occurred via five stages: (1) initiation of tissue injury, (2) upregulation of inflammation via generation of messenger signals, (3) signalling and amplification, (4) ulceration and inflammation and (5) healing. The pathogenesis of stomatitis is multifactorial and complex. 1 Masuda et al reported a preventive effect of rebamipide in a randomised, multicenter phase 2 study of breast cancer patients with chemotherapy-induced stomatitis treated with 5-fluorouracil, epirubicin and cyclophosphamide, or with docetaxel and cyclophosphamide (TC), 2 and showed that about 60% of patients in both groups developed stomatitis. 1 Stomatitis occurs in approximately 20%–40% of patients receiving conventional chemotherapy, 80% of patients receiving high-dose chemotherapy as conditioning for haematopoietic stem cell transplantation, and in nearly all patients receiving head and neck radiation therapy. Stomatitis can be painful, affect the patient’s nutrition and quality of life, and have a significant economic impact. ![]()
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