© 2001 by Oxford University Press
Journal of the National Cancer Institute Monographs, No. 29, 6,
2001
© 2001 Oxford University Press
Introduction
Affiliations of authors:D. E. Peterson, School of Dental Medicine, Department of Oral Diagnosis, University of Connecticut Health Center, Farmington; S. T. Sonis, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Divisions of Oral Medicine, Oral and Maxillofacial Surgery, and Dentistry, Boston, MA.
Correspondence to: Douglas E. Peterson, D.M.D., Ph.D., School of Dental Medicine, Department of Oral Diagnosis, University of Connecticut Health Center, 263 Farmington Ave., Farmington, CT 06030-1605 (e-mail: Peterson{at}NSO.UCHC.EDU).
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INTRODUCTION |
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 Top Introduction |
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A review of mucositis publications during the past 15 years reveals a number of trends. For example, there has been a quantitative leap relative to the number of publications citing mucositis in cancer models; slightly more than 100 studies appeared in the literature in 1986 in contrast to well over 400 studies in 1998. It is likely this escalating pace has been sparked by three factors: 1) recognition of mucositis as an important cancer therapy dose-limiting toxicity, 2) high incidence of mucositis in relation to optimal regimens of tumoricidal therapy, and 3) biologic complexity of the condition.
An increasing proportion of studies in recent years has evaluated mechanistic aspects of mucosal injury. Consequently, understanding of the pathophysiology of mucositis has been strategically advanced. It now seems clear that mucositis represents the endpoint of a process that includes virtually all cell and tissue types within mucosa and that is subject to alteration by local environment and genetic predisposition. Ironically and despite the number of recent studies reporting interventional clinical trials, an effective treatment for mucositis has, to date, been elusive. Thus, mucositis remains an important clinical toxicity for which novel management approaches are needed. Its diverse biologic and clinical nature lends itself to a collaborative effort to ameliorate the condition.
The proceedings reported in this monograph derive from the Conference on Mucosal Injury in Cancer Patients: New Strategies for Research and Treatment. The symposium was held in Bethesda, MD, May 24–25, 2000, and attracted an eclectic mix of clinicians and scientists that reflected a broad constituency of those interested in mucositis. Approximately one half (51%) of the 120 attendees were from either hospitals or medical or dental schools, 33% were from industry, and 16% traveled the short physical distance from the National Institutes of Health or the Food and Drug Administration. The professional training, research backgrounds, and clinical interests of participants were diverse; basic and translational scientists, radiation and medical oncologists, oral medicine specialists, nurses, general dentists, and dental hygienists all were in attendance. Geographic diversity was also a hallmark. While the majority of participants came from throughout the United States, other countries and continents including Canada, Europe, Australia, New Zealand, and Asia were also well represented.
The National Institutes of Health play a key role in determining the national agenda for biomedical research. The substantial scientific and financial support of the conference by the National Institute of Dental and Craniofacial Research reflected recognition of the importance of mucositis as both a clinical and scientific problem.
Because of the unmet clinical needs in patients, mucosal injury has become an important niche area for pharmaceutical and biotechnological development. Thus, industry has also exhibited a leading role in driving the science that has enhanced understanding of the pathophysiology of the condition. In reality, industry will likely convert basic discovery in this area to clinically successful therapy. Industrial support, evidenced by attendance at the meeting as well as provision of financial resources, was a clear demonstration of a collective corporate commitment both to advance the field and to develop efficacious products for patients at risk for mucosal injury.
The agenda for the conference was designed to combine structured presentations in conjunction with workgroups and broad discussion. This approach, in turn, was directed to the ultimate goal of defining substantive and fruitful areas for future investigation.
Text for the formal presentations establishes the basis for this monograph. A summary of the plenary session that evolved based on workgroup proceedings also provides important perspectives for the future research directions and is included as well.
We are pleased that the conference proceedings are being published in the monograph series of the Journal of the National Cancer Institute (JNCI), and we thank the JNCI Editorial Board and monograph production team for their support. Access to the monograph will be available through the Web site of the National Cancer Institute (http://www.nci.nih.gov) and in turn from the National Oral Health Information Clearinghouse Web site (http://www.nohic.nidcr.nih.gov).
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