Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology
Oral medicineOnline only articleOral ulcers in patients with advanced breast cancer receiving everolimus: a case series report on clinical presentation and management
Section snippets
Patients
Seven of 15 women with hormone-receptor-positive, recurrent or progressive advanced breast carcinoma, treated with everolimus (10 mg daily) combined with exemestane (25 mg daily), who developed stomatitis were prospectively evaluated from April 2012 to September 2012. Written informed consent was obtained from all patients.
Methods
Patients reporting the occurrence of oral pain during the course of antitumor therapy were referred to trained assessors for oral assessment. Oral lesions were recorded in
Results
All patients had an Eastern Cooperative Oncology Group (ECOG) performance status of 0 and adequate organ and hematologic functions.22 All patients had metastatic disease, mainly visceral and/or bone, and had received prior treatment for their primary tumor. Seven of 15 patients (46.7%) complained of oral pain and were consequently diagnosed with mTORI stomatitis. The characteristics of the 2 groups, group 1 (patients without stomatitis) and group 2 (patients with stomatitis), are shown in
Discussion
In this report we prospectively assessed the clinical features, management, course and clinical outcome of oral ulcers in a series of 7 of 15 women (46.6%) with advanced breast cancer who received everolimus combined with exemestane.
The 46.6% prevalence of stomatitis, all grades, was within the range reported previously, in clinical trials, in patients receiving different mTORIs.8, 9, 10, 11, 12, 13, 15, 16, 23, 24, 25 Oral ulcer prevalence was closer to that reported when everolimus was
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Cited by (23)
Dexamethasone to prevent everolimus-induced stomatitis (Alliance MIST Trial: A221701)
2023, Seminars in OncologyStomatitis associated with mammalian target of rapamycin inhibition: A review of pathogenesis, prevention, treatment, and clinical implications for oral practice in metastatic breast cancer
2018, Journal of the American Dental AssociationPrevention of everolimus-related stomatitis in women with hormone receptor-positive, HER2-negative metastatic breast cancer using dexamethasone mouthwash (SWISH): a single-arm, phase 2 trial
2017, The Lancet OncologyCitation Excerpt :Management of mTOR inhibitor-associated stomatitis by dose delays, reductions, or discontinuation of the mTOR inhibitor might compromise duration and intensity of therapy and might affect decisions to initiate treatment with mTOR inhibitors.3 Aphthous ulcers have been treated successfully by steroid-containing oral paste or rinse; anecdotal reports suggested that topical steroids could improve healing of everolimus-associated aphthous ulcers.3,8,10 Until now, clinical evidence has been scarce to guide mTOR inhibitor-associated stomatitis prophylactic strategies.
MTOR inhibitor-associated stomatitis (mIAS) in three patients with cancer treated with everolimus
2015, Oral Surgery, Oral Medicine, Oral Pathology and Oral RadiologyCitation Excerpt :As in a previous report,1 all cases presented here were considered to be grade 2, although one of the patients had been pretreated with sunitinib malate, and the other two were using exemestane concurrently. Previous chemotherapy and concurrent use of other antineoplastic agents or exemestane may have no effect1,9 or increase3 the incidence of mIAS, but a combination of mTORI with other antineoplastic drugs is usually associated with more severe symptoms.3,9 No other oral adverse events of mTORI, that is, xerostomia, taste alteration, or gingival swelling, and gastrointestinal or skin involvement,5,6,8 were reported by our patients.
Proniosomes as a novel drug carrier system for buccal delivery of benzocaine
2014, Journal of Drug Delivery Science and TechnologyAdverse event management of mTOR inhibitors during treatment of hormone receptorepositive advanced breast cancer: Considerations for oncologists
2014, Clinical Breast CancerCitation Excerpt :Although specific strategies to prevent or manage (or both) everolimus-associated stomatitis are not well documented, the use of specific oral steroid rinses (eg, dexamethasone solution) and steroid-based mouthwashes (eg, “miracle mouthwash” or “magic mouthwash” formulations) has been suggested for preventing and treating mTOR inhibitor–associated stomatitis (Table 2).52-54 Previous reports have suggested that stomatitis can be mitigated with the use of a 5% dexamethasone oral rinse.50,55 Additionally, the use of a steroid mouth rinse is currently being evaluated to treat stomatitis as a secondary end point in the BOLERO-4 study as well as to prevent stomatitis in a phase II trial of everolimus plus exemestane in HR+/HER− advanced BC (ClinicalTrials.gov identifier: NCT02069093).