MASCC/ISOO Clinical Practice Statement: management of oral complications of immunotherapy

The MASCC/ISOO Clinical Practice Statement (CPS) endeavors to develop a succinct instrument for clinicians, encapsulating essential practical information requisite for the management of oral complications in oncology patients. This CPS specifically addresses the management of oral complications associated with immunotherapy.

This CPS was formulated through a rigorous literature review, followed by a structured discussion among a consortium of leading experts, members of the Oral Care Study Group of MASCC/ISOO. Immunotherapeutic agents were identified utilizing PubMed, and then they were matched with the National Cancer Institute's compendium of Food and Drug Administration-approved immunotherapy drugs. The statement integrated information from the literature about the management of oral immune-related adverse events (irAEs), extrapolation from literature about the management of similar oral diseases, and the working group's clinical experience. The information is systematically presented in concise bullet points and tables, thereby creating a succinct manual delineating the optimal standard of care.

Oral irAEs encompass a range of mucosal and gingival conditions, dysgeusia, dysphagia, and xerostomia/hyposalivation. The management of oral toxicities is contingent upon the severity of the symptoms. Topical steroids and immunomodulators are frequently utilized as first-line therapies for oral mucosal toxicities, and topical anesthetics are employed for pain management. Treatment strategies for dysgeusia primarily focus on symptom management. This CPS also provides a guide for oral and dental care for patients undergoing immunotherapy.

The management of oral toxicities induced by immunotherapy is intended to mitigate patient discomfort, enhance healing, and regain oral function. Optimal management practices necessitate a collaborative approach between medical professionals and oral health specialists.