Botox mitigates debilitating dry mouth in prostate cancer patients receiving radiopharmaceutical therapy

Medical Xpress / Society of Nuclear Medicine and Molecular Imaging / Journal of Nuclear Medicine ^ | June 25, 2025 | Tianzhi Zhao, et al

[ConservativeMind]

Salivary gland toxicity from radiopharmaceutical therapy—particularly from alpha-emitting therapies like 225Ac-PSMA—is a critical dose-limiting side effect, often leading to debilitating dry mouth. Prior attempts to alleviate dry mouth using cold packs, single anticholinergics, or external cooling have shown minimal protective benefit.

A dual-protective approach using botulinum toxin (Botox) alongside an anti-nausea patch significantly reduces salivary gland toxicity in patients with metastatic prostate cancer undergoing PSMA-targeted radiopharmaceutical therapy.

The strategy led to a 30% decrease in PSMA uptake by the salivary glands without affecting the treatment's cancer-fighting efficacy. This reduction may enhance treatment adherence and improve overall patient outcomes.

"In order for patients to maintain a good quality of life and continue with their treatments, it's essential to address these serious dry mouth issues," said Tianzhi Zhao.

Fourteen patients were enrolled in the study and received Botox injections in the parotid and submandibular glands on opposite sides of the body three to four weeks prior to their combined 225Ac- and 177Lu-PSMA radiopharmaceutical therapy.

Three days before treatment, nausea patches were applied behind the ears where they remained until two hours after the treatment. Molecular imaging was performed pre- and post-treatment to measure salivary gland uptake.

A significant reduction in PSMA radioligand uptake in the salivary glands was observed. Botox-treated parotid glands showed a mean 30% reduction in PSMA uptake compared to the opposite parotid gland.

A mean 17% reduction in PSMA uptake was observed in injected submandibular glands compared to the opposite submandibular glands. The injections were well tolerated, with patients reporting mild injection pain but no serious or systemic side effects. No patient discontinued PSMA therapy due to dry mouth.

"The significance of this work lies in its direct patient benefit and its potential to expand the therapeutic utility of PSMA radiopharmaceutical therapy, particularly with alpha-emitting radionuclides like 225Ac."

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TOPICS: Health/Medicine
KEYWORDS: botox; cancer; prostate; radiopharmaceutical

[ConservativeMind]

Both patches are currently available to be used for this therapy.

[ConservativeMind]

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[mairdie]

Fascinating. Anything that can help relieve treatment side effects is to be applauded and cherished.

[Lizavetta]

Botox has other uses not related to wrinkles. It can be helpful in dealing with migraines, excessive underarm sweating, and an overactive bladder.