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Stomatitis in mTOR inhibitors treatment and other targeted cancer therapy, possibilities of infl uencing it, and the use of local corticotherapy


Authors: Samuel Vokurka 1;  Šárka Kozáková 2;  Veronika Jánská 3;  Anežka Černá 1;  Jan Liška 4
Authors‘ workplace: Onkologická a radioterapeutická klinika LF UK a FN Plzeň 1;  Ústavní lékárna, MOÚ Brno 2;  Lékárna, FN Plzeň 3;  Stomatologická klinika FN Plzeň 4
Published in: Klin Onkol 2020; 33(6): 436-439
Category: Review

Overview

Background: Stomatitis associated with targeted oncological therapy, typically everolimus related one, belongs among the major complications affecting the quality of life of a patient and intensity of his/her oncological treatment. Corticosteroids, especially for topical application, represent a major therapeutic and possibly prophylactic intervention. Purpose: Basic summary of clinical characteristics, incidence and overview of possibilities of influencing the incidence of stomatitis related to targeted oncological therapy. Results: When treated with everolimus, the overall incidence of stomatitis is about two thirds of the patients. A solution with dexamethasone sodium phosphate 0.1 mg/mL (0.01%) in the SWISH study showed a significant reduction in the complication when used as prophylactic mouthwash during the treatment with everolimus, and the solution is also suggested by the Europan Society for Medical Oncology guidelines for treatment in stomatitis with ulcers. The availability of topical dexamethasone is variable with respect to the concentration, type of dexamethasone salt and the formula. Conclusion: Solutions containing dexamethasone are an integral part of oral care during targeted oncological therapy; however, the standardization of indications and prescriptions for standard use in practice still remains an open topic.

Keywords:

stomatitis – nursing – dexamethasone – molecular targeted therapy


Sources

1. MeSH Descriptor Data 2020. [online]. National Institute of Health, US National Library of Medicine, USA. Avail­able from: https: //meshb.nlm.nih.gov/record/ui?ui=D052016.

2. Raber-Durlacher J, Barasch A, Peterson E et al. Oral complications and management considerations in patients treated with high-dose cancer chemotherapy. Support Cancer Ther 2004; 1 (4): 219–229. doi: 10.3816/ SCT.2004.n.014.

3. Sonis S, Treister N, Chawla S et al. Preliminary characterization of oral lesions associated with inhibitors of mammalian target of rapamycin in cancer patients. Cancer 2010; 116 (1): 210-215. doi: 10.1002/cncr.24696.

4. Peterson DE, Boers-Doets CB, Bensadoun RJ et al. Management of oral and gastrointestinal mucosal injury: ESMO Clinical Practice Guidelines for dia­gnosis, treatment, and follow-up. Ann Oncol 2015; 26 (Suppl. 5): v139–v151. doi: 10.1093/annonc/mdv202.

5. Elting LS, Chang YC, Parelkar P et al. Risk of oral and gastrointestinal mucosal injury among patients receiving selected targeted agents: a meta-analysis. Support Care Cancer 2013; 21 (11): 3243–3254. doi: 10.1007/s00520-013-1821-8.

6. Laplante M, Sabatini DM. mTOR signaling in growth control and disease. Cell 2012; 149 (2): 274–293. doi: 10.1016/j.cell.2012.03.017.

7. Vokurka S, Hugo J. Everolimus. In: Vokurka S, Hugo J (eds). Moderní molekuly v onkologii. 1. vyd. Praha: Maxdorf 2019: 120–123.

8. Villa A, Aboalela A, Luskin KA et al. mTOR inhibitor-associated stomatitis in hematopoietic stem cell transplant patients receiving sirolimus prophylaxis for graft-versus-host disease. Biol Blood Marrow Transplant 2015; 21 (3): 503–508.

9. Rugo HS, Pritchard KI, Gnant M et al. Incidence and time course of everolimus-related adverse events in postmenopausal women with hormone receptor-positive advanced breast cancer: insights from BOLERO-2. Ann Oncol 2014; 25 (4): 808–815. doi: 10.1093/annonc/mdu009.

10. Motzer RJ, Escudier B, Oudard S et al. Phase 3 trial of everolimus for metastatic renal cell carcinoma: final results and analysis of prognostic factors. Cancer 2010; 116 (18): 4256–4265. doi: 10.1002/cncr.25219.

11. Yao JC, Shah MH, Tetsuhide Ito et al. Everolimus for advanced pancreatic neuroendocrine tumors. N Engl J Med 2011; 364 (6): 514–523. doi: 10.1056/NEJMoa1009290.

12. Pavel ME, Hainsworth JD, Baudin E et al. Everolimus plus octreotide long‑acting repeatable for the treatment of advanced neuroendocrine tumours associated with carcinoid syndrome (RADIANT‑2): a randomised, placebo‑controlled, phase 3 study. Lancet 2011; 378 (9808): 2005–2012. doi: 10.1016/S0140-6736 (11) 61742-X.

13. Rugo HS, Hortobagyi GN, Yao J et al. Meta-analysis of stomatitis in clinical studies of everolimus: incidence and relationship with efficacy. Ann Oncol 2016; 27 (3): 519–525. doi: 10.1093/annonc/mdv595.

14. Vokurka S, Votavová M, Arnetová V et al. Everolimus v denní klinické praxi se zaměřením na problematiku postižení sliznice dutiny ústní – zkušenost onkologického centra v průběhu roku 2016. Klin Onkol 2017; 30 (Suppl 1): 195–197.

15. Souhrn údajů o přípravku, Afinitor tbl. Státní ústav pro kontrolu léčiv ČR a Evropská léková agentura. [online]. Dostupné z: https: //www.ema.europa.eu/en/documents/product-information/afinitor-epar-product-information_cs.pdf.

16. Rugo HS, Seneviratne L, Beck JT et al. Prevention 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. Lancet Oncol 2017; 18 (5): 654–662. doi: 10.1016/S1470-2045 (17) 30109-2.

17. de Oliveira MA, Martins EMF, Wang Q et al. Clinical presentation and management of mTOR inhibitor-associated stomatitis. Oral Oncol 2011; 47 (10): 998–1003. doi: 10.1016/j.oraloncology.2011.08.009.

18. Pilotte AP, Hohos MB, Polson KM et al. Managing stomatitis in patients treated with Mammalian target of rapamycin inhibitors. Clin J Oncol Nurs 2011; 15 (5): e83–89. doi: 10.1188/11.CJON.E83-E89.

19. Jones VL, Jensen LL, McIntyre KJ et al. Evaluation of miracle mouthwash (MMW) plus hydrocortisone versus prednisolone mouth rinses as prophylaxis for everolimus-associated stomatitis: preliminary results of a randomized phase II study. [online]. Available from: https: //www.ncbi.nlm.nih.gov/pmc/articles/PMC6738305/

20. Šípová S, Vrabcová L, Živná V et al. Obecné a specifické možnosti péče o sliznice dutiny ústní pacientů při chemoterapii, radioterapii a cílené terapiu. [abstrakt]. Klin Onkol 2019; 32 (Supl 1): XII/294, 65.

21. Souhrn údajů o přípravku, Dexamed inj sol. Státní ústav pro kontrolu léčiv ČR a Evropská léková agentura. [online]. Dostupné z: http: //www.sukl.cz/modules/medication/detail.php?code=0084090&tab=texts.

22. Sklenář Z, Ščigel V (eds). Magistraliter receptura ve stomatologii. 2. vyd. Praha: Havlíček Brain Team 2013.

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