Pilocarpine may prevent radiation-induced xerostomia in head and neck cancer patients: Study

To assess long-term efficacy and side effects of pilocarpine on irradiated head and neck cancer (HNC) patients in both for prevention and treatment of radiation-induced xerostomia (RIX). Retrospective observational study was conducted. Eligibility criteria included irradiated HNC patients who received pilocarpine at least 12 weeks either for prevention (group A) or for treatment (group B) of radiation-induced xerostomia. They collected the documented Late Effect Normal Tissue Task Force-Subjective, Objective, Management, Analytics subjective/objective grades of radiation-induced xerostomia before (only group B) and the latest visit for pilocarpine prescription, dosage, side effects, duration of treatment, and the cause of discontinuation.

Results: Between December 2007 and June 2022, 182 patients were enrolled including 95 patients (52%) in group A and 87 patients (48%) in group B. Group A patients reported grades 1, 2, 3, and 4 objective radiation-induced xerostomia in 0%, 7%, 93%, and 0%. Grade 1, 2, and 3 subjective radiation-induced xerostomia were 57%, 28%, and 15%. All patients in group B had grade 3 both objective/subjective radiation-induced xerostomia. The overall improvement of objective/subjective radiation-induced xerostomia was found in 40%/83%. Discontinuation was found in 51% of patients due to tolerable symptoms or deterioration of the patient's status. Based on this retrospective analysis, long-term use of pilocarpine in irradiated HNC appears feasible for both the prevention and treatment of radiation-induced xerostomia.

Kittichet, R., Chitapanarux, I., Kittidachanan, K., & Sripan, P. (2024). A real-life experience of long-term use of pilocarpine in irradiated head and neck cancer patients. Oral Diseases, 00, 1–8. https://doi.org/10.1111/odi.14905