mTOR inhibitor-associated stomatitis (mIAS) in three patients with cancer treated with everolimus

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

“…Despite results show that stomatitis caused by mTOR inhibitors are often mild and self‐limiting, different attempts to manage mIAS have been reported in the literature. The treatments more frequently used are Magic Mouthwash composed of lidocaine gel 2% × 30 g, doxycycline suspension 50 mg/5ml × 60 ml, and sucralfate oral suspension 1,000 mg/5 ml dissolved in sodium chloride 0.9% × 2,000 ml used for 3–15 days (Kalogirou, Tosios, Piperi, & Sklavounou, ), a sodium bicarbonate‐based mouthwash combined with oral fluconazole (Ferte et al., ) or a combination of dexamethasone solution 0.5 mg/ml and miconazole 2% gel (Nicolatou‐Galitis, Nikolaidi, Athanassiadis, Papadopoulou, & Sonis, ). 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., ).…”

Oral mucosal injury caused by mammalian target of rapamycin inhibitors: emerging perspectives on pathobiology and impact on clinical practice

“…As noted in Table 3, prophylactic measures to prevent mIAS have been proposed by expert panel groups 17, 46, 47. In comparison, study of the use of topical or systemic corticosteroids for mIAS treatment suggests their possible efficacy 14, 48, 49. A single‐center retrospective analysis of patients with cancer treated with the mTOR inhibitors everolimus or ridaforolimus determined that 87% of patients reported clinical improvement of mIAS (87%) after treatment with topical or systemic corticosteroids 48.…”

Breast cancer patients have increased risk of developing mTOR inhibitor‐associated stomatitis

“…The development time of mIAS ranged between 7 and 14 days (median of 10 days) (de Oliveira et al., ). Considered one of the main adverse effects and an important signal of dose‐limiting toxicity, such lesions indicate a possible need to decrease the daily dose of everolimus (Kalogirou, Tosios, Piperi, & Sklavounou, ; Nicolatou‐Galitis, Nikolaidi, Athanassiadis, Papadopoulou, & Sonis, ). In this study, patients who used everolimus were evaluated, of which 31.3% presented mIAS, and 92% of such lesions were located in non‐keratinized mucosa (oral floor, tongue, buccal, and lip).…”