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O efeito na cavidade oral dos antineoplásicos sistémicos e biológicos
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Abstract(s)
A terapêutica antineoplásica tem registado avanços consideráveis com a introdução de agentes antineoplásicos sistémicos e ,mais recentemente, de terapias alvo e imunomoduladoras, designadas genericamente como agentes biológicos. Apesar da eficácia destas estratégias no controlo e erradicação das células tumorais, ambas estão associadas a efeitos adversos relevantes na cavidade oral, os quais podem comprometer a função oral, o estado nutricional e a qualidade de vida dos doentes oncológicos, bem como condicionar a adesão e a continuidade do tratamento.
Os antineoplásicos sistémicos clássicos, nomeadamente os agentes citotóxicos, atuam de forma inespecífica sobre células com elevada taxa de proliferação, originando manifestações orais agudas, previsíveis e frequentemente severas, como mucosite, xerostomia, ulcerações, candidíase e disgeusia. Em contrapartida, os agentes biológicos, incluindo anticorpos monoclonais e inibidores dos checkpoints imunológicos, apresentam maior seletividade molecular, mas podem desencadear toxicidades orais de natureza imunomediada, menos frequentes, mas potencialmente persistentes, de diagnóstico mais complexo e evolução clínica variável.
A presente dissertação analisa comparativamente os mecanismos de ação, os perfis de toxicidade e as manifestações clínicas orais associadas a ambas as categorias farmacológicas, com base na literatura científica atual. Através desta análise, conclui-se que as diferenças entre os dois grupos de fármacos exigem abordagens preventivas e terapêuticas diferenciadas, reforçando a necessidade de integrar a medicina dentária nos cuidados oncológicos de forma sistemática e precoce.
São ainda apresentadas recomendações futuras com vista à melhoria da vigilância e intervenção multidisciplinar, ao desenvolvimento de estratégias terapêuticas baseadas na evidência e ao investimento em investigação orientada para a minimização das complicações orais associadas à terapêutica antineoplásica.
Antineoplastic therapy has made considerable advances with the introduction of systemic antineoplastic agents and more recently, targeted and immunomodulatory therapies, generically referred to as biological agents. Despite the effectiveness of these strategies in controlling and eradicating tumour cells, both are associated with significant adverse effects in the oral cavity, which can compromise oral function, nutritional status and quality of life in cancer patients, as well as affecting adherence to and continuity of treatment. Classic systemic antineoplastic drugs, namely cytotoxic agents, act nonspecifically on cells with high proliferation rates, causing acute, predictable and often severe oral manifestations, such as mucositis, xerostomia, ulcerations, candidiasis and dysgeusia. In contrast, biological agents, including monoclonal antibodies and immune checkpoint inhibitors, have greater molecular selectivity but can trigger immunemediated oral toxicities that are less frequent but potentially persistent, more complex to diagnose and variable in clinical progression. This dissertation comparatively analyses the mechanisms of action, toxicity profiles and oral clinical manifestations associated with both pharmacological categories, based on the current scientific literature. Through this analysis, it is concluded that the differences between the two groups of drugs require different preventive and therapeutic approaches, reinforcing the need to integrate dentistry into cancer care in a systematic and early manner. Future recommendations are also presented with a view to improving multidisciplinary surveillance and intervention, developing evidence-based therapeutic strategies, and investing in research aimed at minimising oral complications associated with antineoplastic therapy.
Antineoplastic therapy has made considerable advances with the introduction of systemic antineoplastic agents and more recently, targeted and immunomodulatory therapies, generically referred to as biological agents. Despite the effectiveness of these strategies in controlling and eradicating tumour cells, both are associated with significant adverse effects in the oral cavity, which can compromise oral function, nutritional status and quality of life in cancer patients, as well as affecting adherence to and continuity of treatment. Classic systemic antineoplastic drugs, namely cytotoxic agents, act nonspecifically on cells with high proliferation rates, causing acute, predictable and often severe oral manifestations, such as mucositis, xerostomia, ulcerations, candidiasis and dysgeusia. In contrast, biological agents, including monoclonal antibodies and immune checkpoint inhibitors, have greater molecular selectivity but can trigger immunemediated oral toxicities that are less frequent but potentially persistent, more complex to diagnose and variable in clinical progression. This dissertation comparatively analyses the mechanisms of action, toxicity profiles and oral clinical manifestations associated with both pharmacological categories, based on the current scientific literature. Through this analysis, it is concluded that the differences between the two groups of drugs require different preventive and therapeutic approaches, reinforcing the need to integrate dentistry into cancer care in a systematic and early manner. Future recommendations are also presented with a view to improving multidisciplinary surveillance and intervention, developing evidence-based therapeutic strategies, and investing in research aimed at minimising oral complications associated with antineoplastic therapy.
Description
Dissertação para obtenção do grau de Mestre no Instituto Universitário Egas Moniz
Keywords
Antineoplásicos Agentes biológicos Cavidade oral Toxicidade