Mucositis and Stomatitis Management in ADC Therapy: Prevention, Treatment, and Supportive Care

In this expert discussion, Dr. Hope Rugo, Dr. Aaron Lisberg, Liz Castronovo, NP, and Stephanie McDonald, NP examine mucositis and stomatitis management in antibody-drug conjugate (ADC) therapy for breast and lung cancer.

The panel emphasizes proactive prevention, early recognition, and multidisciplinary care to maintain treatment continuity while minimizing oral toxicity. Prophylactic strategies include patient education on oral hygiene, rigorous hydration, baking soda or saltwater rinses, baseline dental evaluation, alcohol-free mouthwash, and cryotherapy with ice chips during infusions. Castronovo highlights dexamethasone rinses as an effective symptomatic intervention, while McDonald notes that stomatitis with certain ADCs (notably datopotamab deruxtecan) is common but predominantly low-grade and rarely leads to discontinuation. She recommends a prophylactic steroid-containing mouthwash and advises patients to avoid eating or drinking for about an hour after use; alternatives such as non-alcoholic or bicarbonate rinses are appropriate where steroid rinses are unavailable.

Key considerations include encouraging patient compliance with rinse regimens, monitoring hydration and nutritional status, and escalating therapy when needed. For more painful cases, McDonald outlines a stepwise approach from topical steroids to viscous lidocaine, and then to morphine mouth rinse in severe scenarios Dr. Lisberg confirms a similar approach, incorporating prophylactic steroid mouthwash, cryotherapy, and escalation to oral steroids for severe cases. The discussion underscores the importance of thorough oral examinations to identify superinfections and the role of dose holds and reductions for significant stomatitis while maintaining patients on effective therapy. Overall, the speakers stress proactive education, accessible patient resources, and multidisciplinary coordination to maximize ADC benefits while safeguarding mucosal health.