Oral Toxicities Associated with Immune Checkpoint Inhibitors: Meta-Analyses of Clinical Trials

Author:

Srivastava Akanksha1ORCID,Nogueras-Gonzalez Graciela M.2,Geng Yimin3,Singh Jasdev4,Myers Jeffrey N.5,Li Yisheng2,Chambers Mark S.6

Affiliation:

1. 1 Craniofacial Center, Division of Plastic Surgery, Department of Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA

2. 2 Department of Biostatistics, Division of Basic Sciences, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

3. 3 Research Medical Library, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

4. 4 DMD-1 student, Midwestern University, Downers Grove, IL, USA

5. 5 Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

6. 6 Section of Oral Oncology and Maxillofacial Prosthodontics, Department of Head and Neck Surgery, Division of Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

Abstract

ABSTRACT Immune checkpoint inhibitors (ICIs) have revolutionized cancer treatment; however, their oral toxicity profile is not well elucidated. This review aimed to investigate the prevalence of oral toxicities including xerostomia, mucositis/stomatitis, dysgeusia, dysphagia, oral/oropharyngeal pain, oral infections, angular cheilitis, osteonecrosis, osteomyelitis, and oral mucosal reactions with ICIs. A review protocol was registered with PROSPERO (ID: CRD42023391674). A systematic search of ClinicalTrials.gov was conducted as of April 10, 2022. Studies were selected, assessed, and data extracted using PRISMA guidelines. Oral toxicity data were extracted from study arms using a single immunotherapy drug. Meta-analyses were conducted to summarize prevalence of oral toxicities using random-effects models. Of 750 screened records, 95 trials were included in the meta-analysis with published results. Time between study completion and first publication on ClinicalTrials.gov was 1 to 146 months (mean = 20.3, SD = 18.4). Weighted pooled prevalence was 5% (95% CI: 4–6%) for xerostomia, 3% (95% CI: 3–4%) for mucositis/stomatitis, 3% (95% CI: 2–3%) for dysgeusia, 2% (95% CI: 1–2%) for dysphagia, 3% (95% CI: 2–4%) for oropharyngeal/oral pain, 2% (95% CI: 1–3%) for oral candidiasis, and 2% (95% CI: 0–4%) for angular cheilitis. Subgroup differences based on ICI drugs were minimal. No trials reported lichenoid or pemphigoid mucosal reactions. Meta-analysis results revealed low prevalence of oral toxicities with ICIs; however, data reporting was limited and inconsistent. Limitations of study dataset reveal a significant need for systematic collection of oral morbidity data as well as improved consistency and compliance of reporting results on ClinicalTrials.gov.

Publisher

Innovative Healthcare Institute

Subject

Cancer Research,Oncology,Immunology,Immunology and Allergy

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