Mucositis and personalised cancer medicine: supportive care makes excellent cancer care possible


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Dorothy Keefe1,2
1University of Adelaide, Adelaide, South Australia, Australia,2SA Cancer Service, Adelaide, South Australia, Australia

Abstract

Cancer treatments become ever more complex over time, and the holy grail is tailored, personalised cancer medicine. However, most research in this field concentrates on interactions between tumour and treatment, somewhat downplaying those between treatment and host. We divide patients into Toxic and Non-Toxic Responders and Non-Responders, without fully exploring the implications.

The field of Supportive Care in Cancer (SCC) concentrates on the effects of cancer, and its treatment, on the patient. As cancer treatments evolve, so does supportive care. We have become experts at treatment and prevention of some of the common side effects of chemotherapy and radiotherapy, such as emesis and febrile neutropenia; but the new, targeted anti-cancer therapies bring new toxicities, some of which are rare but potentially devastating. SCC has to keep pace.

Mucositis can act as a demonstration toxicity - its mechanism after chemotherapy and radiotherapy is being more fully understood, leading to prevention and treatment strategies. Targeted agents cause a different mucosal damage (ranging from aphthous-like ulceration from m-TOR inhibitors to immune colitis and bowel perforation from immune checkpoint inhibitors), and newer combinations can be deadly.

Patients rarely suffer from a single toxicity, and links between toxicities show the potential for shared treatment if the mechanism can be targeted. Accurate risk prediction has remained elusive, but recent work in potential genomic risk prediction is very exciting.

Mucositis mechanism, connections and treatments; SCC and its integration into cancer care; and the future of SCC in the targeted and genomics era, will all be discussed.