title: mTOR inhibitor-associated stomatitis (mIAS) in three patients with cancer treated with everolimus.
abstract: Mammalian targets of rapamycin inhibitors (mTOR inhibitors, mTORI) are indicated for the management of several cancer types, including hormone receptor--positive or HER2-negative breast cancer, advanced renal cell carcinoma, advanced neuroendocrine tumors of pancreatic origin, and tuberous sclerosis complex-related tumors. Among the most common adverse events of mTORI medication are discrete, large, solitary or multiple, superficial ulcers, almost exclusively situated on nonkeratinized oral mucosa, described as mTORI-associated stomatitis (mIAS). We describe the clinical presentation, course, and management of mIAS in three patients receiving the mTORI everolimus (Afinitor, Novartis, East Hanover, NJ). In two patients, mIAS manifested 9 and 30 days after first using everolimus, respectively, whereas in the third patient, it recurred 3 months after re-introduction of everolimus. Oral rinses with a "magic mouthwash" solution (dexamethasone oral drops solution 2 mg/mL × 10 mL, lidocaine gel 2% × 30 g, doxycycline suspension 50 mg/5 mL × 60 mL, and sucralfate oral suspension 1000 mg/5 mL × 150 mL, dissolved in sodium chloride 0.9% × 2000 mL) four times daily proved helpful in alleviating the symptoms, and the ulcers healed in 4 to 15 days. No side effects were recorded, and dose reduction or discontinuation of everolimus was not necessitated in two cases.
authors.affiliation: Postgraduate Student, Department of Oral Pathology and Medicine, Dental School, University of Athens, Athens, Greece.
authors.forename: Eleni-Marina
authors.initials: EM
authors.lastname: Kalogirou
authors.affiliation: Assistant Professor, Department of Oral Pathology and Medicine, Dental School, University of Athens, Athens, Greece. Electronic address: ktosios@dent.uoa.gr.
authors.forename: Konstantinos I
authors.initials: KI
authors.lastname: Tosios
authors.affiliation: Lecturer, Department of Oral Pathology and Medicine, Dental School, University of Athens, Athens, Greece.
authors.forename: Evangelia P
authors.initials: EP
authors.lastname: Piperi
authors.affiliation: Professor, Department of Oral Pathology and Medicine, Dental School, University of Athens, Athens, Greece.
authors.forename: Alexandra
authors.initials: A
authors.lastname: Sklavounou
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000009:adverse effects*; D001943:Breast Neoplasms / Q000188:drug therapy; D002292:Carcinoma, Renal Cell / Q000188:drug therapy; D000068338:Everolimus; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis / Q000188:drug therapy; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives*; D013280:Stomatitis / Q000139:chemically induced* / Q000628:therapy
chemical_list: D000970:Antineoplastic Agents; D000068338:Everolimus; D020123:Sirolimus