Introduction Head and neck cancers (HNC) treatments often cause a metallic taste (MT), adversely affecting patients’ quality of life. This study aims to investigate the lipoperoxidation hypothesis of MT by examining salivary malondialdehyde (MDA) levels, a marker of oxidative stress, in HNC patients undergoing treatment.

Methods This prospective cohort study included 44 newly diagnosed HNC patients. Saliva samples were collected before, during and up to one year after the HNC treatment. Analyses including MDA and other markers were performed. Additionally, a bovine lactoferrin mouthwash was evaluated for its efficacy in alleviating MT.

Results Out of the 44 patients, 12 (27.2%) reported MT, primarily during treatment phases. Salivary MDA levels significantly increased during radiotherapy, peaking mid-treatment, before declining post-treatment. Despite this fluctuation, no significant relationship was found between MDA levels and MT. Bovine lactoferrin mouthwash alleviated MT at least partially in 63.2% of the occurrences. Other salivary markers such as protein concentration, antioxidant properties, catalase activity, and superoxide dismutase activity showed no significant link to MT.

Discussion The increase in MDA levels during radiotherapy indicated heightened oxidative stress. However, the lack of a significant association between MDA and MT suggests other factors may contribute to MT development. The partial efficacy of lactoferrin mouthwash highlighted a potential benefits. Future research should explore other mechanisms, such as the role of oral microbiota, to better understand and manage MT in HNC patients.

The authors have declared no competing interest.

NCT03558789

This study was funded by Ligue contre le Cancer de la Drome et de l'Ardeche

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

CPP Est I, Dijon, France (#2017-A03641-52).

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes