Palifermin reduces the incidence of severe mucositis in patients with cancer, but the agent remains underused, according to research published in Critical Reviews in Oncology/Hematology.1

Researchers conducted a meta-analysis, which indicated that palifermin can reduce the incidence of severe mucositis by up to 30% in patients receiving chemotherapy and/or radiotherapy to treat solid tumors or hematologic malignancies.

Despite this benefit, “routine adoption [of palifermin] in clinical practice is not common,” the researchers wrote. The team conducted their meta-analysis to “synthesize the published literature on palifermin [and] ascertain recommendations for practice.”

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Meta-Analysis Details

The meta-analysis included 10 randomized controlled trials testing palifermin for the management (treatment or prevention) of oral mucositis in patients receiving chemotherapy and/or radiotherapy for solid tumors or hematologic malignancies.

When compared with no palifermin or placebo, palifermin decreased the incidence of grade 3 or 4 mucositis in all patients (relative risk [RR], 0.69; 95% CI, 0.59-0.81; P <.0001), those with solid tumors (RR, 0.76; 95% CI, 0.63-0.92; P =.004), and those with hematologic malignancies (RR, 0.63; 95% CI, 0.48-0.82; P =.0007).

Palifermin also decreased the incidence of any mucositis and shortened the duration of mucositis in patients who did experience it, the researchers noted. There was a benefit with palifermin in both pediatric and adult patients across cancer types.

Palifermin was particularly beneficial for patients with head and neck cancers and patients with hematologic malignancies who underwent hematopoietic stem cell transplant and received total body irradiation as part of conditioning.

In dose-escalation studies, palifermin demonstrated activity at doses greater than 10 mcg/kg per day. In most of the studies analyzed, the dose was 60 mcg/kg per day administered for 3 days before and 3 days after chemotherapy or radiotherapy.

A few studies examined slightly modified doses and showed an efficacy benefit with a similar incidence and severity of adverse events, especially in solid tumors. The researchers therefore concluded that a weekly dose of 120-180 mcg/kg before chemoradiotherapy in solid tumors may significantly reduce the severity and duration of mucositis.

“We encourage further research to explore various dosing regimens and patient populations to further attempt to optimize its use,” said study author John Coutsouvelis, senior clinical pharmacist at Alfred Health in Melbourne, Australia.