Clinical Scorecard: Oral Toxicities With Antibody-Drug Conjugates: What Physicians Should Know

At a Glance

Key Highlights

• In a cohort of 207 patients, 22.7% developed at least one oral toxicity.
• Oral mucositis occurred in 14.8% of patients receiving TROP2-directed therapy and 5.4% receiving HER2-directed therapy; adjusted odds were approximately three times higher with TROP2-directed ADCs.
• Mucositis lesions most often involved the tongue, were frequently painful, and tended to appear earlier with TROP2-directed treatment.
• Xerostomia and dysgeusia were more common with HER2-directed therapy, but differences were not statistically significant.
• Topical corticosteroids did not improve existing mucositis or prevent new lesions in this cohort; cryotherapy observations involved only four patients.

Guideline-Based Recommendations

Diagnosis

• The article recommends asking patients specifically about oral symptoms, including dry mouth and taste changes.
• The article notes that a baseline oral assessment before ADC therapy may help identify existing problems and recommends examining new lesions during treatment.

Management

• The article recommends considering referral to an oral medicine specialist when symptoms are persistent, painful, or difficult to manage.
• In this cohort, topical corticosteroids did not improve existing mucositis or prevent new lesions. Cryotherapy observations involved four patients and require prospective study before firm treatment recommendations can be made.

Monitoring & Follow-up

• The article recommends regular discussion of oral symptoms after ADC therapy begins and timely examination of new lesions.
• The source reports that oral pain or ulceration can interfere with eating and that dry mouth and taste changes can affect daily life.

Risks

• Oral pain or ulceration can interfere with eating; dry mouth and taste changes can affect daily life.
• Patients receiving TROP2-directed ADCs had more mucositis and more frequent dose reductions than those receiving HER2-directed therapy in this cohort.
• The retrospective design, predominance of patients with breast cancer, and reliance on medical records may limit generalizability and may have resulted in underreporting.

Patient & Prescribing Data

Multicenter retrospective cohort of 207 patients with advanced cancer treated with TROP2- or HER2-directed ADCs; most participants had breast cancer.

Dose reductions occurred in 26.1% of patients receiving TROP2-directed therapy and 14.1% receiving HER2-directed therapy. Supportive treatment for oral complications was more common in the TROP2 group. Cryotherapy was used in four patients, with observed symptomatic improvement and fewer new ulcerative lesions.

Clinical Best Practices

• The article recommends assessing oral health before ADC treatment and asking directly about oral symptoms during follow-up.
• Examine new oral lesions and consider specialist referral when symptoms are persistent, painful, or difficult to manage.
• The source cautions against applying supportive-care strategies from one drug class to another without evidence of similar benefit.
• Interpret the reported treatment observations cautiously because the study was retrospective and cryotherapy data were limited.

Related Resources & Content

• The Oncologist multicenter retrospective cohort study described in the article