Oral mucosal changes induced by anticancer targeted therapies and immune checkpoint inhibitors

Area of Science:

• Oncology
• Dermatology
• Pharmacology

Background:

• Biological targeted therapies and immune checkpoint inhibitors have revolutionized cancer treatment.
• These novel therapies are associated with a spectrum of previously unrecognized toxicities.
• Oral adverse events are common but often poorly characterized, lacking specific terminology.

Purpose of the Study:

• To review and characterize the distinct oral mucosal toxicities associated with emerging anticancer therapies.
• To differentiate these toxicities from those caused by traditional chemotherapy and radiotherapy.
• To discuss the clinical management of these novel oral side effects.

Main Methods:

• Comprehensive literature review of oral toxicities linked to targeted therapies and immune checkpoint inhibitors.
• Categorization of oral side effects based on drug class and mechanism of action.
• Analysis of clinical presentation, incidence, and management strategies.

Main Results:

• Oral toxicities of targeted therapies exhibit characteristic features distinct from classic chemotherapy/radiotherapy effects.
• Specific examples include mammalian target of rapamycin (mTOR) inhibitor-associated stomatitis (mIAS), VEGFR/PDGFR inhibitor-associated stomatitis, glossitis, and osteonecrosis of the jaw.
• Other discussed toxicities include EGFR inhibitor-induced mucositis, BRAF inhibitor hyperkeratosis, imatinib-related pigmentary changes/lichenoid reactions, TDM-1-associated syndrome, and PD-1 inhibitor oral toxicities.

Conclusions:

• Targeted anticancer therapies induce a unique array of oral mucosal toxicities that significantly impact patient morbidity.
• Accurate characterization and understanding of these specific oral side effects are crucial for effective clinical management.
• Further research and structured data collection are needed, particularly for newer agents like PD-1 inhibitors.