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Cancer therapy–related salivary dysfunction
Cristina Paz, … , Grace C. Blitzer, Randall J. Kimple
Cristina Paz, … , Grace C. Blitzer, Randall J. Kimple
Published September 3, 2024
Citation Information: J Clin Invest. 2024;134(17):e182661. https://doi.org/10.1172/JCI182661.
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Review

Cancer therapy–related salivary dysfunction

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Abstract

Salivary gland dysfunction is a common side effect of cancer treatments. Salivary function plays key roles in critical daily activities. Consequently, changes in salivary function can profoundly impair quality of life for cancer patients. We discuss salivary gland anatomy and physiology to understand how anticancer therapies such as chemotherapy, bone marrow transplantation, immunotherapy, and radiation therapy impair salivary function. We discuss approaches to quantify xerostomia in the clinic, including the advantages and limitations of validated quality-of-life instruments and approaches to directly measuring salivary function. Current and emerging approaches to treat cancer therapy–induced dry mouth are presented using radiation-induced salivary dysfunction as a model. Limitations of current sialagogues and salivary analogues are presented. Emerging approaches, including cellular and gene therapy and novel pharmacologic approaches, are described.

Authors

Cristina Paz, Annemarie Glassey, Abigail Frick, Sarah Sattar, Nicholas G. Zaorsky, Grace C. Blitzer, Randall J. Kimple

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Figure 3

Effects of cancer therapies on the salivary glands.

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Effects of cancer therapies on the salivary glands.
(A) Acute and chroni...
(A) Acute and chronic responses to cancer treatment are associated with fibrosis and damage to salivary acini, including changes to endothelial and myoepithelial cells as well as serous and mucous epithelial cells. Recent studies have indicated a role for T cell activation and other indicated changes in immunotherapy-related salivary dysfunction, while macrophages have been shown to be involved in damage response following radiotherapy. (B) Timeline of known effects of radiotherapy, chemotherapy, and immunotherapy on salivary glands. Solid bars represent approximate start and end time of indicated changes; a dashed bar indicates presumed changes. Gray wedge indicates the decline of overall incidence of these responses in patients over time. Effects of radiotherapy have been well described; however, few descriptions of mechanisms underlying chemotherapy or immunotherapy-driven changes have been described. Adapted from Jasmer et al. (20).

Copyright © 2025 American Society for Clinical Investigation
ISSN: 0021-9738 (print), 1558-8238 (online)

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