title: Mammalian target of rapamycin inhibitor-associated stomatitis.
abstract: With the recent introduction of inhibitors of mammalian target of rapamycin (mTOR) in oncology, distinct cutaneous and oral adverse events have been identified. In fact, stomatitis and rash are documented as the most frequent and potentially dose-limiting side effects. Clinically, mTOR inhibitor-associated stomatitis (mIAS) more closely resembles aphthous stomatitis than oral mucositis due to conventional anticancer therapies. While most cases of mIAS are mild to moderate and self-limiting, more severe and persistent mIAS can become a dose-limiting toxicity. Small ulcerations may cause significant pain and mucosal sensitivity may occur in the absence of clinical changes. Use of clinical assessment tools that are primarily driven by ulceration size may underestimate mIAS, and assessment should include patient-reported outcomes. This article provides an up-to-date review of the clinical presentation, terminology, pathogenesis, assessment and management of mIAS and other mTOR inhibitor-associated oral adverse events. In addition, areas of future research are considered.
authors.affiliation: Department of Clinical Oncology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: Christine B
authors.initials: CB
authors.lastname: Boers-Doets
authors.forename: Judith E
authors.initials: JE
authors.lastname: Raber-Durlacher
authors.forename: Nathaniel S
authors.initials: NS
authors.lastname: Treister
authors.forename: Joel B
authors.initials: JB
authors.lastname: Epstein
authors.forename: Anniek B P
authors.initials: AB
authors.lastname: Arends
authors.forename: Diede R
authors.initials: DR
authors.lastname: Wiersma
authors.forename: Rajesh V
authors.initials: RV
authors.lastname: Lalla
authors.forename: Richard M
authors.initials: RM
authors.lastname: Logan
authors.forename: Nielka P
authors.initials: NP
authors.lastname: van Erp
authors.forename: Hans
authors.initials: H
authors.lastname: Gelderblom
mesh_terms: D064420:Drug-Related Side Effects and Adverse Reactions / Q000145:classification / Q000473:pathology*; D006801:Humans; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage* / Q000009:adverse effects; D020123:Sirolimus / Q000008:administration & dosage / Q000009:adverse effects; D013281:Stomatitis, Aphthous / Q000139:chemically induced* / Q000473:pathology; D058570:TOR Serine-Threonine Kinases / Q000037:antagonists & inhibitors
chemical_list: D047428:Protein Kinase Inhibitors; D058570:TOR Serine-Threonine Kinases; D020123:Sirolimus