Clinical presentation and management of mTOR inhibitor-associated stomatitis
Clinical presentation and management of mTOR inhibitor-associated stomatitis
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DOI：
10.1016/j.oraloncology.2011.08.009
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发表时间：
2011-10-01
期刊：
影响因子：
4.8
通讯作者：
Treister, Nathaniel S.
中科院分区：
文献类型：
--
作者：
de Oliveira, Marcio Augusto;Martins e Martins, Fabiana;Treister, Nathaniel S.
抑制mTOR通路的抗癌药物与许多独特的毒性有关，其中最重要和潜在剂量限制的毒性之一是口腔炎。本研究的目的是报道一系列癌症患者发生疼痛性mTOR抑制剂相关性口炎（mIAS）的临床特征和治疗结果。17名癌症患者在丹娜-法伯癌症研究所接受依维莫司或利达福莫司治疗时发生mIAS，并被转至口腔医学诊所进行评估和管理。总结了临床特点、毒性处理和结果。此外，还评估了减少剂量和停止治疗的频率和理由。mTOR抑制剂治疗的中位持续时间为80天（范围9-187天）。发生口腔溃疡的中位时间为10天（范围4-25天）。5名患者由于2级和3级口炎需要减少治疗方案指导剂量，1名患者由于口腔溃疡停止癌症治疗。据报道，86.6%的患者在局部、病灶内或全身皮质类固醇治疗后，临床改善和疼痛缓解，副作用仅限于继发性念珠菌病（n = 2）。口腔溃疡是与癌症治疗中使用mTOR抑制剂相关的常见和潜在剂量限制性毒性。本病例系列表明，局部和全身皮质类固醇治疗是治疗症状性mIAS患者的有效方法。前瞻性研究对于评估治疗和预防策略的有效性是必要的，其最终目标是改善整体癌症治疗结果。(C) 2011 Elsevier Ltd.版权所有。
Anti-cancer agents that inhibit the mTOR pathway are associated with a number of unique toxicities, with one of the most significant and potentially dose-limiting being stomatitis. The objective of this study was to report the clinical features and management outcomes of a series of cancer patients who developed painful mTOR inhibitor-associated stomatitis (mIAS). Seventeen cancer patients developed mIAS while being treated with everolimus-or ridaforolimus-containing protocols at the Dana-Farber Cancer Institute and were referred to the oral medicine clinic for evaluation and management. Clinical characteristics, toxicity management, and outcomes were summarized. In addition, the frequency and rationale for dose reductions and therapy discontinuation were assessed. The median duration of mTOR inhibitor therapy was 80 days (range 9-187 days). The median time to development of mouth ulcers was 10 days (range 4-25 days). Five patients required protocol-directed dose reductions due to grades 2 and 3 stomatitis and one patient discontinued cancer treatment due to mouth ulcers. Clinical improvement and pain relief was reported in 86.6% of patients following topical, intralesional, or systemic corticosteroid therapy, with side effects limited to secondary candidiasis (n = 2). Mouth ulcers are a common and potentially dose limiting toxicity associated with the use of mTOR inhibitors in cancer treatment. This case series demonstrates that local and systemic corticosteroid therapy is an effective approach to managing patients with symptomatic mIAS. Prospective studies are necessary to evaluate the effectiveness of treatment and prevention strategies with the ultimate goal of improving overall cancer treatment outcomes. (C) 2011 Elsevier Ltd. All rights reserved.