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Cetuximab and Oral Mucositis: Is it Different from Oral Mucositis Caused by Other Drugs?

Daniela Musio *,Francesca De Felice ,Nadia Bulzonetti ,Vincenzo Tombolini

Purpose: To estimate frequency of oral mucositis in treatment for head and neck cancer with radiotherapy and concurrent cetuximab and to determine whether it has different characteristics from mucositis caused by other drugs.

Materials and methods: Subjects with locally advanced, primary non-metastatic, squamous cell carcinoma located in the oropharynx were treated with radiation therapy plus concomitant cetuximab. Results: None of patients received their full planned course of combination treatment due to excessive mucosal toxicity. All patients developed oral mucositis within about 10-15 days: it began directly, without escalation, as grade ≥ 3; it was associated with severe pain and trismus; it was never associated to specific supra-infections; the evolution and the consequent resolution of clinical discomfort required several days and the treatment with corticosteroids did not represent the solution formula.

Conclusion: Cetuximab induced oral mucositis have the following specific characteristics: time of onset, mode of clinical expression, severity, association with trismus and minimal response to corticosteroid therapy. Considering that the majority of studies do not reveal oral toxicity associated with cetuximab, future clinical trials should focus on specific topics to improve the definition of documented oral toxic effects.