Chemotherapy mucositis with

The rapidly proliferating cells of the GI tract make them susceptible to the effects of chemotherapy. Mucositis is the inflamed, ulcerated mucosa of the mouth, esophagus, and lower GI tract that may result in infection and pain with subsequent decreased fluid and nutritional intake. Methotrexate, 5-FU, etoposide, and doxorubicin are the chemotherapy agents most commonly associated with mucositis. Patients should be instructed on good oral mouth care and use saline rinses several... 

A related anthracenedione, mitoxantrone, has been approved for use in AML. Mitoxantrone has limited ability to produce quinone-type free radicals and causes less cardiac toxicity than does doxorubicin. It produces acute myelosuppression, cardiac toxicity, and mucositis as its major toxicities the drug causes less nausea and vomiting and alopecia than does doxorubicin. It is also used as a component of experimental high-dose chemotherapy regimens, with uncertain efficacy. 

Sorensen JB, Skovsgaard T, Bork E, Damstrup L, Ingeberg S. Double-blind, placebo-controlled, randomized study of chlorhexidine prophylaxis for 5-fluorouracil-based chemotherapy-induced oral mucositis with nonblinded randomized comparison to oral cooling (cryotherapy) in gastrointestinal malignancies. Cancer 2008 112(7) 1600-6. 

Cytarabine is used in the chemotherapy of acute myelogenous leukemia, usually in combination with anthracyclines, thioguanine, or both. It is less useful in acute lymphoblastic leukemia and lymphomas and has marginal activity against other tumors. Myelosuppres-sion is a major toxicity, as is severe bone marrow hypoplasia nausea and mucositis may also occur. 

Provide patient education regarding common toxicities associated with chemotherapy, such as nausea/vomiting, mucositis, myelosuppression, and alopecia. 

Mucositis Inflammation of mucous membranes, typically within the oral and esophageal mucosa. Mucositis is usually associated with certain chemotherapy agents and radiation therapy involving mucosal areas. 

An example of a simple CZE method for peptide analysis and characterization is the one developed for protegrin IB-367.37 IB-367 is a peptide containing 17 amino acid residues that possess antimicrobial properties, and it is being developed for treatment of oral mucositis associated with aggressive cancer chemotherapy as well as other topical applications. This polycationic product was chemically synthesized using solid-phase and purified by preparative reversed-phase HPLC. IB-367 is rich in cysteine and arginine residues. 

For immunosuppressive effects methotrexate is most frequently used in RA but also azathioprine and cyclosporin are employed. Methotrexate doses for this indication can be lower than those used for cancer chemotherapy but significant toxicity such as nausea, cytopenias and mucosal lesions, and with longterm therapy slowly progressive hepatotoxicity may still be seen. 

Mucositis (premyelotoxic therapy) IV 60 mcg/kg/day for 3 consecutive days, with the 3rd dose 24-48 hr before chemotherapy. 

It is indicated in mucosal candidiasis, systemic candidiasis, crypttococcosis, prophylaxis of fungal infections following cytotoxic chemotherapy or radiotherapy maintenance to prevent relapse of cryptococcal meningitis in patients with AIDS sporotrichosis, histoplasmosis and vaginal candidiasis. 

G. Other applications Neupogen may also be useful in preventing opportunistic diseases in patients infected with the human immunodehciency virus and for drug-induced agranulocytosis. The use of topical hlgrastim may be effective in reducing oral mucositis due to intensive chemotherapy. 

Palifermin (r-KGF) Kepivance (Amgen) Oral mucositis in hematologic cancer with chemotherapy and radiation therapy and bone marrow transplant... 

Doria MI Jr, Doria LK, Faintuch J, Levin B. Gastric mucosal injury after hepatic arterial infusion chemotherapy with floxuridine. A chnical and pathologic study. Cancer 1994 73(8) 2042-7. 

A 12-year-old boy with prostatic rhabdomyosarcoma had episodes of syncope periodically over 7 months while taking fluconazole for chemotherapy-induced mucositis. He had taken fluconazole in the past without problems but had also taken a stable dose of amitriptyline for neuropathic pain. On withdrawal of amitriptyline he had no further episodes. The effect was confirmed by re administration. 

Radiation recall consists of inflammatory reactions triggered by cytotoxic drugs in previously irradiated areas most are skin reactions. Gemcitabine has been implicated in several cases. The authors of a literature review discovered 12 cases of radiation recall caused by gemcitabine and reported a case of myositis in the rectus abdominis muscle of a patient with pancreatic adenocarcinoma as an effect of radiation recall (23). Most of the cases had inflammation of internal organs or tissues and 30% had dermatitis or mucositis. This is different from the effect of other agents that commonly cause radiation recall (anthracyclines and taxanes), with which 63% are skin reactions. Compared with anthracyclines and taxanes, the interval from the completion of radiation therapy to the start of chemotherapy is less with gemcitabine (median time 56 days, compared with 218 days for the taxanes and 646 days for doxorubicin). 

Al-Khafaji AH, Dewhirst WE, Cornell CJ Jr, Quill TJ. Succinylcholine-induced hyperkalemia in a patient with mucositis secondary to chemotherapy. Crit Care Med 2001 29(6) 1274-6. 

Systemic azole agents are used for treating OPC in patients who have failed or who are unable to take topical therapy. The preceding discussion on the relative efficacy of fluconazole, itraconazole, and ketocoanzole in HIV-infected patients may be extrapolated to the non-HIV-infected population. Fluconazole 100 to 200 mg daily is used more commonly because of more extensive experience with its use, and it is more effective and has a more favorable absorption and side-effect profile compared with ketoconazole. If the oral route is not feasible for reasons such as severe chemotherapy-induced mucositis, fluconazole may be administered intravenously. In patients mire-sponsive to azoles, intravenous amphotericin B in relatively low doses... 

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