Charlotte cancer specialist develops low-tech treatment for mouth sores

As a pediatric oncologist, Dr. Peter Anderson long ago noticed that, when children are diagnosed with cancer, parents often ask what foods or supplements will help during treatment.

That got him thinking. And he realized it’s not so much about what to eat as it is about being able to eat.

It’s often difficult for cancer patients to eat because of mouth sores.

Also called mucositis, this inflammation of the mucous membranes in the mouth and digestive tract is a common and painful side effect of chemotherapy and radiation therapy. And it’s a major reason why cancer patients don’t get all the nutrition they need.

Anderson started working on the problem in the early ’90s. And this fall, the Carolinas HealthCare System physician announced his solution to the world at an international medical conference in Toronto.

It’s not a drug or a food. It’s a special mouthwash called Healios.

Developed by Anderson with multiple collaborators, Healios has been shown to minimize mouth sores and enable patients to eat enough to keep up their strength.

Anderson’s interest in the subject goes back about 20 years, when he worked in a bone marrow transplant unit at the University of Minnesota. One day he noticed that 11 of 12 patients were on morphine drips because “they had really bad mouth sores.”

When he searched the medical literature to find out “what makes healing faster,” he learned that “critically ill patients did better if they had some glutamine.” It’s an amino acid that is “the fuel for your intestines and the lining of your mouth, just like glucose is the fuel for your brain,” Anderson said.

But the answer wasn’t as simple as buying glutamine in a health food store. Sprinkling glutamine on food wouldn’t help if mouth sores made it hard for a child to chew or swallow.

So Anderson consulted a University of Minnesota pharmacist who helped him develop a sweetened glutamine liquid that was tested in three randomized, double-blind, placebo-controlled studies. And the results were good. “There was strong evidence that glutamine in a good-tasting solution works,” Anderson said. “It reduced mouth sores.”

And that enabled patients to eat. “If you can maintain your weight, usually you’ll tolerate the other side effects of chemotherapy better,” Anderson said.

While he was at the Mayo Clinic for 10 years, Anderson continued testing the product. When one pharmacist worried the sweet liquid might cause cavities, they switched from sugar to NutraSweet. It didn’t work, but it led to an important discovery.

Anderson said they learned that sugar helped get “100- to 1,000-fold more glutamine into cells” than NutraSweet. “It took both the sugar and the glutamine to get the glutamine into the cells,” he said. “I was a pediatrician trying to make it good tasting. It was not science. It was serendipity.”

Later, while working at M.D. Anderson Cancer Center in Texas, Anderson collaborated with Labrada, a company that sells nutritional supplements, to improve the product and get it to market.

“We needed a good-tasting powder that could be easily stored and shipped,” Anderson said. Instead of the “messy, sticky solution,” they came up with Healios, a powder of glutamine and sugars that can be mixed with water. It comes in orange or grape flavors.

“It tasted better than I thought it ever would,” said Anderson, who moved to Charlotte in 2013. He joined Levine Children’s Hospital as director of pediatric hematology, oncology and blood and marrow transplant.

Swish and swallow

Healios has been on the market since September 2013, according to Alex Rodriguez, a representative with the Healios Oncology Nutrition, the start-up company in Texas.

Rodriguez said the “all-natural product” is sold directly to patients as well as pharmacies for $49.99 for a 30-serving supply. It can be purchased online at www.healiosproducts.com. Anderson, who holds the patent, does not benefit financially. The company is just getting started, and Rodriguez is preparing paperwork to begin selling Healios in other countries.

Patients who use it are advised to “swish and swallow” Healios twice a day. To prevent mouth sores, they can start using it even before they begin treatment.

Valerie Miniex, a dietitian with Louisiana Oncology Associates in Lafayette, La., said she has 20 patients with head and neck cancer who are using Healios, and she’s been “amazed at the results.”

She learned about it three months ago from a patient who had used it at M.D. Anderson. Separately, Miniex said she had been reading about the effects of glutamine to hasten healing. Miniex said dry mouth and mouth sores are “major issues” for patients with head and neck cancer. “We’re always treating the symptoms. Here was an opportunity to prevent them.”

Only one of her patients has been unable to tolerate Healios, because of acid reflux, Miniex said. “That’s huge to get that kind of response. ... It’s such a problem that we’re all just excited to have something that is working.”

Charlotte fundraiser helped

This fall, Anderson shared the Healios story at the International Society of Paediatric Oncology Congress, before 1,900 doctors from 92 countries. His poster presentation was prepared by Katrina Ashlin, a Davidson College senior who interned with Anderson last summer at Carolinas Medical Center.

Ashlin, a biology major who plans to become a dentist, developed educational materials about Healios and distributed them to nurses and nutritionists, those most likely to work with patients on treating mouth sores.

Ashlin’s work was paid for by Joedance Film Festival, an event that raises money for research into rare pediatric cancers. The festival was created in memory of Joe Restaino, who was 20 when he died in 2010 of osteosarcoma. Over five years, it has raised more than $55,000 for Levine Children’s, where Restaino received some of his care.

His mother, Diane Restaino of Charlotte, said her family is proud to have sponsored Anderson’s project because mouth sores were a “very painful side effect for Joe.”

“He couldn’t eat. It was painful for him to even drink water,” she said. “This would have taken so much pain away from Joe through all of that chemotherapy.”

Because Joe died before Anderson arrived in Charlotte, Restaino hadn’t tried Healios mouthwash when she met with the doctor at CMC. He mixed up a dose and offered it to Restaino, who took a swallow and declared: “It’s really good.”

“This is a huge deal to know that you can go right downstairs to get this,” Diane Restaino said. “It seems like a small thing, but it will make a huge difference to a lot of cancer patients.”

This story was originally published December 15, 2014 at 12:55 PM with the headline "Charlotte cancer specialist develops low-tech treatment for mouth sores."