Using Botox to Reduce Dry Mouth in Prostate Cancer Patients Undergoing Radiopharmaceutical Therapy

Prostate cancer patients treated with radiopharmaceutical therapy, especially with alpha-emitting agents like Actinium-225 (225Ac-PSMA), often face the challenging side effect of severe dry mouth caused by salivary gland toxicity. Traditional methods such as cold packs, anticholinergic drugs, or external cooling have provided limited relief. However, recent research introduces a promising dual-protection strategy involving botulinum toxin (Botox) injections and anti-nausea patches.

In a study presented at the Society of Nuclear Medicine and Molecular Imaging 2025 Annual Meeting, 14 patients received Botox injections into their parotid and submandibular salivary glands three to four weeks before undergoing combined Actinium-225 and Lutetium-177 PSMA radiotherapy. Alongside, patients wore nausea patches behind the ears starting three days prior to treatment, continuing until two hours afterward. Molecular imaging scans before and after therapy revealed a significant reduction in the glands' radioligand uptake.

The results showed an average 30% decrease in PSMA uptake in the treated parotid glands and an 17% reduction in the submandibular glands. The procedure was well tolerated, with only mild discomfort reported, and no participants had to discontinue therapy due to dry mouth. This reduction in salivary gland uptake indicates a lowered risk of damage and dryer mouth symptoms, which can greatly improve patient quality of life.

Dr. Jingjing Zhang, a lead researcher from the National University of Singapore, highlighted that combining Botox with nausea patches is a safe, effective method to protect salivary glands without compromising the therapy's ability to target prostate tumors. Importantly, both Botox and nausea patches are already FDA-approved medications, facilitating easier translation into clinical practice.

This innovative approach might significantly enhance treatment outcomes by reducing salivary gland toxicity, thereby making PSMA-targeted radiotherapy more tolerable. As dry mouth is a common and distressing side effect that impacts patient adherence, this strategy holds promise for improving overall patient well-being during prostate cancer treatment.

Source: https://medicalxpress.com/news/2025-06-botox-mitigates-debilitating-dry-mouth.html