ISTANBUL, Turkey—The frequency and duration of chemotherapy-induced oral mucositis may be significantly improved by either prophylactic chlorhexidine(Drug information on chlorhexidine) or by cryotherapy, according to the results of a randomized, double-blind, placebo-controlled study presented at the 31st Congress of the European Society for Medical Oncology (ESMO) (abstract 988 O).
Cryotherapy consists of ice chips swished around in the mouth during chemotherapy. This diminishes the amount of chemotherapy that reaches the oral mucosa if the chemotherapy is cleared from the blood before the cryotherapy stops. “Cryotherapy is easy and inexpensive,” said lead investigator Jens B. Sorensen, MD, of the National University Hospital, Copenhagen, Denmark, “but is drug- and schedule-dependent as it cannot be used with infusional fluorouracil(Drug information on fluorouracil) [5-FU] or with chemotherapy that has a substantially longer half-life than 5-FU.”
Chlorhexidine mouthwash has had mixed results in previous studies. Dr. Sorensen said that “this uncertainty may partly be due to the various clinical scenarios in which it has been tested.” To clarify the situation, the Danish researchers studied the value of chlorhexidine and cryotherapy only in the preventive setting, in patients with gastrointestinal cancer who were being treated with intravenous bolus 5-FU 425 mg/m2 and leucovorin 20 mg/m2 daily over 5 days. Each of 225 patients was randomly assigned to either chlorhexidine 0.1% 15 mL mouth rinse for 1 minute three times daily for 3 weeks, or normal saline with the same taste additive as in the chlorhexidine group, or to cryotherapy with crushed ice, 10 minutes before to 35 minutes after chemotherapy.
Of the 206 patients who answered a questionnaire, 13% of the chlorhexidine group, 33% of placebo patients, and 11% of cryotherapy patients said they had mucositis that was bad enough to impair eating or require artificial nutrition. The median duration of mucositis was 3 days with chlorhexidine, 5 days with placebo, and 1 day with cryotherapy.