Chlorhexidine mouthwash or ice chips may help prevent chemotherapy-associated oral sores and ulcers, Danish researchers reported at the European Society for Medical Oncology Congress (Abstract 988-Oral).
In a study of 225 patients, both oral cooling with ice chips and chlorhexidine mouthwash significantly reduced the frequency and duration of oral sores following chemotherapy treatment, said Jens Benn Sørensen, MD, Chief of the Department of Oncology at the National University Hospital in Copenhagen.
The patients, all with previously untreated gastrointestinal cancers, were receiving a 425 mg/m2 of bolus fluorouracil (5-FU) plus 20 mg/m2 of leucovorine for five days.
About 40% of patients given bolus chemotherapy containing 5-FU develop mouth sores or ulcers, Dr. Sørenson noted.
The patients were randomly assigned to either rinse with 15 ml of 0.1% chlorhexidine mouthwash for one minute, three times a day for three weeks; to rinse with the same dose and frequency of normal saline; or to swirl ice chips in their mouth for 10 minutes, beginning 10 minutes prior to starting 5-FU and for 35 minutes afterward.
Of the total, 206 answered a questionnaire asking about the frequency and duration of oral mucositis. Grade 3 or 4 mucositis that was bad enough to impair eating or to require artificial nutrition occurred in 12% of patients in the mouthwash arm, 32% of those in the placebo-saline arm, and 10% of those in the cryotherapy arm.
The sores also persisted for a significantly longer time among patients in the placebo group—a median of five days, compared with three days in the chlorhexidine group and one day in the cooling group.
Dr. Sørensen told reporters at a news conference at the meeting that while the ice chips are cheap and associated with the shortest duration of mouth sores, they cannot be used with infusional 5-FU or with chemotherapy agents with substantially longer half-lives than 5-FU.
“Cryotherapy can only be used when the drug is rapidly cleared from the body,” he said. “Chlorhexidine, on the other hand, can be used in adult patients with solid tumors treated with chemotherapy in conventional doses.”