Transcriptomic and Cytokine Profiles Associated with General Pain Symptoms in Head and Neck Cancer Patients with Oral Mucositis Receiving Dental Prophylaxis and Oral Mucosal Deterging Intervention

Authors

• T Goto
• P Corby
• A Lin
• J Lukens
• S Sonis
• LN Saligan

Abstract

Background: Oral mucositis (OM) often affects head and neck cancer (HNC) patients receiving radiation therapy (RT). This study, part of ARMOR-Trial NCT03843554, evaluated the effects of targeted dental prophylaxis and oral mucosal deterging intervention (OMDP) on general pain symptoms, and profiled genetic signatures and cytokine expressions associated with general pain scores.
Methods: HNC patients were randomized to receive OMDP or standard care during RT. General pain scores assessed by EORTC QLQ-C30 were collected at baseline and post-RT. Participants were categorized into pain (changes in the pain scores > 0) and no-pain (change  0) groups. RNA-seq analysis of baseline blood samples and cytokine profiling of post-RT saliva samples were performed associating these profiles with general pain score changes.
Results: OMDP significantly reduced general pain scores. Gene expression analysis identified OMDP-specific pathways, including activated type 1 interferon related and suppressed immune responses related pathways. IL6 (p = .051) and CCL3 (p = .055) in stimulated saliva trended towards difference between the pain and no pain groups in the OMDP arm. CCL4 in the pain group of the OMDP arm was significantly higher than that in the no pain group (p = .041).
Conclusions: Enhanced oral care reduced general pain scores. Pre-RT activated interferon pathways and post-RT upregulated cytokines in saliva suggested pre-existing inflammation in OMDP non-responders. Pre-existing immunosuppression may lead to higher general pain scores among non-responders to enhanced oral care. Pre-RT assessment for immunosuppressive or inflammatory conditions, alongside enhanced oral care, may improve pain management in HNC patients with OM.

Scientific Focus Area: Clinical Research

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