Polaprezinc is a compound containing L-carnosine and zinc ion. This compound has been shown to have some positive effects in the treatment of gastric ulcers and other gastrointestinal mucosal injuries. Poaprezinc was examined for its efficacy in the prevention and management of oral mucositis in patients receiving treatment for cancer.
Doi, H., Fujiwara, M., Suzuki, H., Niwa, Y., Nakayama, M., Shikata, T., . . . Hirota, S. (2015). Polaprezinc reduces the severity of radiation-induced mucositis in head and neck cancer patients. Molecular and Clinical Oncology, 3, 381–386.
To evaluate the feasibility and efficacy of polaprezinc (PZ) for the prevention of oral mucositis (OM) in patients with head and neck cancer receiving radiation therapy
PZ was prepared as an oral rinse (10 ml) and was administered four times per day while patients underwent radiation therapy. The solution was rinsed in the mouth and spat out. Patients were instructed to withhold all food and drink for 30 minutes after rinsing.
Nonrandomized, prospective study with a comparative analysis to a case-matched cohort that underwent a retrospective review
Overall, 93.8% of patients reported no difficulty with the PZ rinse. Two patients withdrew because of nontolerability. There was no statistic significance between groups for grade 3 mucositis. Some clinical significance in increased ability to take oral nutrition was reported. Quality of life increased, but no measurement of quality of life was provided. There was no difference in survival outcomes.
The use of a PZ oral solution was feasible and may lessen adverse clinical symptoms in regard to OM for patients with head and neck cancer receiving radiation therapy.
PZ oral solution, which is a zinc-containing compound, might be helpful in reducing OM and increasing patients’ ability to take oral nutrition. However, more research needs to be completed.
Hayashi, H., Kobayashi, R., Suzuki, A., Ishihara, M., Nakamura, N., Kitagawa, J., . . . Itoh, Y. (2014). Polaprezinc prevents oral mucositis in patients treated with high-dose chemotherapy followed by hematopoietic stem cell transplantation. Anticancer Research, 34, 7271–7277.
To investigate whether polaprezinc is effective in preventing oral mucositis (OM) in patients receiving high-dose chemotherapy and radiation followed by hematopoietic stem cell transplantation (HSCT)
The treatment group received polaprezinc alginate (P-AG) solution rinses four times per day for one month after transplantation. The control group received an azulene oral rinse four times per day for one month after transplantation.
P-AG decreased the incidence of grade 2 or greater OM. The average grade of OM was lower in the P-AG group. There was a decrease in the amount of moderate to severe pain.
P-AG might be effective in lowering the incidence and severity of OM in patients receiving high-dose chemotherapy and radiation followed by HSCT.
P-AG may help in the prevention of OM, but additional study is warranted before a practice change is recommended.
Hayashi, H., Kobayashi, R., Suzuki, A., Yamada, Y., Ishida, M., Shakui, T., . . . Itoh, Y. (2016). Preparation and clinical evaluation of a novel lozenge containing polaprezinc, a zinc-L-carnosine, for prevention of oral mucositis in patients with hematological cancer who received high-dose chemotherapy. Medical Oncology, 33, 91-016-0795-z.
To evaluate the clinical effect of a newly developed lozenge containing polaprezinc for the prevention of oral mucositis in patients who received conditioning high-dose chemotherapy for hematopoietic stem cell transplantation (HSCT) compared to a polaprezinc (zinc-L-carnosine) suspension in a sodium alginate solution that has been shown to be effective in the prevention of oral mucositis in patients who received radiotherapy or high-dose chemotherapy
Patients were pretreated with either polaprezinc suspension during January 2013 and December 2014 or polaprezinc lozenge during January 2015 and December 2016 for the prevention of oral mucositis. The control group consisted of patients who received high-dose chemotherapy without any premedication during March 2006 and February 2011. The incidence and severity of oral mucositis and its associated symptoms, such as oral pain, were reviewed from medical records and compared among the three groups. The severity of adverse events was graded according to the Common Terminology Criteria for Adverse Events (CTCAE), version 3.0.
PHASE OF CARE: Active antitumor treatment
Retrospective cohort comparison
CTCAE, version 3.0
The results showed grade 2 and grade 3 oral mucositis in the no-premedication control group. The polaprezinc suspension group and the polaprezinc lozenge group showed less incidence of grade 2 mucositis, and the overall average grade of oral mucositis was 0.6 for the suspension group and lozenge group. No statistical difference existed in the average grade or incidence rate of oral mucositis between the suspension group and lozenge group.
The newly developed lozenge containing polaprezinc for the prevention of oral mucositis was shown to be highly effective in the prevention of moderate to severe oral mucositis in patients receiving high-dose chemotherapy for HSCT. There was some question about the efficacy of the lozenge preparation when compared to the suspension.
Gender was not clearly identified, and the method of evaluating the grade of mucositis was not clearly described. The lozenge is not a readily available product, developed and compounded for this study. The product has promise if the study is replicated as randomized, controlled trial.
Suzuki, A., Kobayashi, R., Shakui, T., Kubota, Y., Fukita, M., Kuze, B., . . . Itoh, Y. (2016). Effect of polaprezinc on oral mucositis, irradiation period, and time to discharge in patients with head and neck cancer. Head and Neck, 38, 1387–1392.
To determine whether polaprezinc suspension in sodium alginate (P-AG) reduces the irradiation period and time to discharge after completion of radiotherapy in patients with head and neck cancer and improves the overall survival in patients with head and neck cancer who received radiotherapy
The incidence of grade 3 OM was significantly lower in the P-AG group than in the control group (16.5% versus 52%, p = 0.0003). P-AG also significantly reduced the median duration of radiotherapy (HR = 0.557, 95% CI [0.357, 0.871], p = 0.0149) and median time to discharge after completion of radiotherapy (HR = 0.604, 95% CI [0.386, 0.946], p = 0.028).
P-AG was useful for preventing OM and reducing the irradiation period and median time to discharge after the completion of radiotherapy.
Randomized and multi-institutional designs are needed to clarify the beneficial effect of P-AG on the incidence of OM and hospitalization.