Β’ Propaideytiki Pathology Clinic, Peripheral General Hospital of Athens, Oncology Department, “Attikon” School of Medicine, National and Kapodistrian University of Athens, 12461 Athens, Greece
Nikolaos Tsoukalas
Oncology Department, 401 General Military Hospital, 11525 Athens, Greece
Evangelos Galitis
Clinic of Oral Surgery, School of Dentistry, National and Kapodistrian University of Athens, 11527 Athens, Greece
3rd Pathology Clinic, General Hospital for Thoracic Diseases of Athens “Sotiria”, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
The oral problems of 24 cancer patients on immunotherapy between 2017–2022 and referred by their oncologists, were reported. The age range was 49–80 years, and the median was 64 years. Lung cancer was the most common disease. Three patients a had history of autoimmune disease prior to cancer diagnosis. Patients received immunotherapy for two to 48 months. Prior to immunotherapy, 17 patients received cytotoxic chemotherapy, five angiogenesis inhibitors and one1 radiotherapy to head/neck. During immunotherapy, four patients received chemotherapy, one received bevacizumab, and eight received bone targeting agents, either alone or in combination. Presenting symptoms were oral pain (18 patients, 75%), dental pain (five patients), xerostomia (five patients), burning/itching (seven patients), bleeding (three patients), swelling (three patients), and taste problems (dysgeusia) (three patients). One patient was asymptomatic. Immune-related lesions were observed in 15 patients (62.50%), of which three were exacerbations of prior autoimmune disease. Three patients reported severe deterioration and itching after using a mouthwash. We also observed six (25%) infections (four candidiasis and two herpes simplex), and six (25.00%) cases of medication-related osteonecrosis of the jaw (MRONJ). Five of those MRONJ cases developed among the eight patients with the administration of bone targeting agents and one in a patient with bevacizumab. Two patients presented with more than one lesion. In conclusion, immune-related lesions were most common; oral infections and MRONJ were also observed. Various oral complications might be related to the interplay between immunotherapy and other therapies prior or concurrent to immunotherapy.
