(1) Patients treated with high-dose
chemotherapy combined with total body irradiation (myeloablative
therapy) often develop
oral mucositis. Prevention is based mainly on sucking
ice during
chemotherapy. (2)
Palifermin is a
growth factor marketed for the prevention of severe
oral mucositis in adults with malignant haemopathies who are receiving myeloablative
therapy followed by peripheral stem cell
autografting. (3)
Palifermin has not been compared with sucking
ice, despite the efficacy of this simple treatment. (4) In a randomised placebo-controlled double-blind trial involving 212 adult patients treated with high-dose
chemotherapy and total body irradiation,
palifermin reduced the incidence of severe
oral mucositis (63% versus 98%) and its duration (about 3 days versus 9 days). The myeloablative regimen used in this trial is not that commonly used in Europe. The efficacy of
palifermin during less aggressive regimens, which cause less severe
oral mucositis, is not known. (5) The main adverse events noted in clinical trials were
erythema and cutaneous oedema. It is not known whether
palifermin increases the long-term risk of
cancer. (6) Treatment with
palifermin is expensive, 4800.00 euros in France); the optimal dosing schedule is not known and the unit dose chosen by the manufacturer is wastefully large. (7) In practice, it remains to be demonstrated that
palifermin is more effective than simply sucking
ice.