Everolimus-associated stomatitis in a patient who had renal transplant

Abstract

Everolimus is used as an immunosuppressant in renal allograft transplant rejection and in metastatic breast cancer treatment. One side effect of everolimus is stomatitis, referred to as mammalian target of rapamycin inhibitor-associated stomatitis. This side effect can affect treatment course and contribute to discontinuation of therapy or dose reduction, previously reported in the treatment of metastatic breast cancer. Here, we present a case of everolimus-associated stomatitis with a novel management method with intralesional triamcinolone that allows for continuous course of everolimus.

Oral stomatitis and mTOR inhibitors: A review of current evidence in 20,915 patients

“…An alternative treatment is that based on a combination of topical anesthetics, a Magic Mouthwash (composed of lidocaine, aluminum hydroxide, magnesium hydroxide, dimethicone suspension, diphenhydramine, equal parts) clobetasol gel 0.05%, dexamethasone 0.1 mg/ml, triamcinolone paste, intralesional triamcinolone, systemic prednisone (1 mg/kg for 7 days) (de Oliveira et al., ). However, literature on treatment of mIAS is poor, and management of mIAS is still largely based on assessment and education of patients on oral hygiene measures, diet modifications, and pain management (Boers‐Doets et al., ; Ji, Aboalela, & Villa, ). Until today, it cannot be determined which lesions will be self‐limiting and which can determine a poor quality of life, leading to complications such as malnutrition and dose reduction in medically necessary treatment.…”

Oral administration of salmon cartilage proteoglycan extends the survival of allografts in mice

“…Calcineurin inhibitors are associated with nephrotoxicity, cardiotoxicity and neurotoxicity (18), while everolimus induces stomatitis (19). These side effects affect the treatment course, such as discontinuation of therapy or dose reduction (19). To prolong the time before graft rejection during these irregular treatment courses, administration of mild immunosuppressive agents becomes an attractive option.…”

“…The majority of immunosuppressive agents act non-selectively, resulting in common side effects, including increased susceptibility to infections and decreased cancer immunosurveillance. Calcineurin inhibitors are associated with nephrotoxicity, cardiotoxicity and neurotoxicity (18), while everolimus induces stomatitis (19). These side effects affect the treatment course, such as discontinuation of therapy or dose reduction (19).…”

Use of everolimus in liver transplantation

“…Stomatitis has also been reported as one of the common adverse effects when EVR was used as maintenance immunosuppressive therapy[ 22 , 24 ]. Management strategies for stomatitis include the use of local anesthetic, intralesional and topical steroid to control stomatitis and reduce pain[ 41 , 44 , 45 ]. EVR has also been used as an alternative for renal transplant recipients who experienced sirolimus-induced stomatitis[ 46 ].…”