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Zinc-L-Carnosine for Oral Mucositis in Pediatric Cancer Patients

4/24/2019 1:32:39 PM
Oral mucositis is one of the most common complications of cancer chemotherapy and radiation. Moreover, the incidence of oral mucositis in pediatric and adolescent patients is 3 times higher than in adults because of a higher rate of basal cell proliferation. Children who receive high-dose chemotherapy followed by hematopoietic stem cell transplantation (HSCT) are at high risk of developing oral mucositis.

Some zinc formulations already proven effective in preventing oral mucositis in adult patients

Polaprezinc suspension in sodium alginate (PZ-AG) has been shown to prevent radiation-induced oral mucositis in adult patients, but its efficacy in children is yet unknown. PZ-AG is a zinc-L-carnosine suspension that is taken orally. It has a good safety profile and is approved in Japan as an anti-ulcerative drug with mucoprotective action. The current study was designed to evaluate the prophylactic effect of PZ-AG against oral mucositis in children with hematological malignancies receiving high-dose chemotherapy followed by HSCT.

Zinc suspension analyzed in pediatric patients

Data from 16 children (aged 1-18 years) were analyzed retrospectively. PZ-AG suspension was prescribed to be rinsed in the mouth for 2 minutes and then swallowed (4 times a day), beginning before chemotherapy and continuing for a month after HSCT. Six of the children refused to take PZ-AG, so these children were instead pretreated with azulene gargle. The final analysis compared the efficacy of PZ-AG with azulene.
The incidence of grade ≥3 oral mucositis was significantly lower in the PZ-AG group than in the azulene group (20% vs. 83%; p=.035), and the average grade of oral mucositis was significantly lower in the PZ-AG group. The prevalence of opioid analgesic use was also significantly lower in the PZ-AG group than in the azulene group (30% vs. 100%). Finally, the average duration of total parenteral nutrition (TPN) was significantly shorter in the PZ-AG group (11 days vs. 24 days). There were no significant differences between groups for clinical outcomes, such as rate of engraftment, time to engraftment, or the rate of overall survival.

Oral zinc therapy may offer safer alternative to existing treatments

Of the numerous therapies that have been tested for the prevention of oral mucositis in pediatric cancer patients, only recombinant human keratinocyte growth factor (KGF) has been shown to offer reliable and reproducible protection. Safety concerns, lack of long-term follow-up data, and the extremely high cost of KGF, however, limits its use. PZ-AG may offer a safe, inexpensive, and effective alternative for the protection against oral mucositis in pediatric cancer patients. Randomized controlled trials are needed.   
Funato M, Ozeki M, Suzuki A et al. Prophylactic Effect of Polaprezinc, a Zinc-L-carnosine, Against Chemotherapy-induced Oral Mucositis in Pediatric Patients Undergoing Autologous Stem Cell Transplantation. Anticancer Res. 2018; 38: 4691-4697.

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