Oral Toxicities of PSMA-Targeted Immunotherapies for The Management of Prostate Cancer

• Published in: Clinical genitourinary cancer 2024-04, Vol.22 (2), p.380-384
• Main Authors: Emperumal, Chitra Priya, Villa, Alessandro, Hwang, Caleb, Oh, David, Fong, Lawrence, Aggarwal, Rahul, Keenan, Bridget P.
• Format: Article
• Language: English
• Subjects: Dipeptides; Dysgeusia - chemically induced; Humans; Immunotherapy; Immunotherapy - adverse effects; Male; Mucositis - chemically induced; Prospective Studies; Prostate cancer; Prostate-Specific Antigen; Prostatic Neoplasms, Castration-Resistant - pathology; Prostatic Neoplasms, Castration-Resistant - therapy; PSMA; Quality of Life; Radiopharmaceuticals; Retrospective Studies; Salivary gland; Treatment Outcome; Xerostomia; Xerostomia - chemically induced
• ISSN: 1558-7673; 1938-0682
• DOI: 10.1016/j.clgc.2023.12.008

Prostate Specific Membrane Antigen (PSMA)-targeted radionucleotide therapy has been shown to cause dry mouth, but the oral manifestations of PSMA-targeted immunotherapy have not been extensively studied. The aim of this study was to describe and quantify the oral manifestations of PSMA-targeted immunotherapies (bispecific antibodies or Chimeric Antigen Receptor T cell therapies) in the management of metastatic castration resistant prostate cancer. We performed a retrospective analysis of the oral toxicities of PSMA-targeted immunotherapies of the patients seen at a single institution's cancer center between 2020 and 2023. Descriptive statistics were used to summarize the data. In a total of 19 patients treated with PSMA-targeted immunotherapies between 2020 and 2023, 9 patients (47%) experienced the following oral toxicities: xerostomia (n = 6; 32%), mucositis (n = 2; 10%), dysgeusia, dry throat and teeth sensitivity in (n = 1 each; 5%), respectively. Oral infections, such as candidiasis and herpes simplex, were not observed in any patients. Mucositis was managed with salt rinses and resolved within few months from onset. Xerostomia persisted in all the patients (median: 306 days, range: 98-484 days) among those who reported dry mouth at the time of data collection, despite treatment with salivary stimulants (n = 5; 83%). Dysgeusia was also persistent, although it was not specifically treated. Patients treated with PSMA-targeted immunotherapies for prostate cancer can present with various short-term and long-term off-tumor on-target oral toxicities including xerostomia and dysgeusia that may affect quality of life. This study serves as a foundation to future prospective studies with a larger sample size and also helps oncologists managing prostate cancer patients with targeted immunotherapies to familiarize common oral toxicities. Furthermore, we emphasize the importance of oral medicine consultation for a comprehensive oral examination and management of oral complications. PSMA-directed radioligand therapies can cause dry mouth; however, there are no studies to date focusing exclusively on the oral toxicities of PSMA-targeted immunotherapies. We found that the adverse effects of PSMA-targeted immunotherapies included dry mouth, dysgeusia, and mucositis. We advocate for the oncology community to be aware of potential oral toxicities and to consider involving oral medicine specialists in patient care.