Everolimus in daily clinical practice focusing to oral mucosa damage issues - single oncology centre experience within the course of the year 2016
Abstract
Backgrounds: oral mucositis, m-TOR associated stomatitis, is a major complication in everolimus (EVE) treatment with an incidence of 44-64 %. The management of it in the daily practice has not been described enough, so far.
Patients and Methods: Retrospective analysis of patients treated with EVE in 2016 at our center, n=42 patients (69 % female), median age 66 (37-81) years, breast cancer in 20 (48 %) and renal cell carcinoma in 22 (52 %), starting EVE dose of 10mg/day in 34 (81%) and 5mg/day in 8 (19%) patients. Results: Discomfort and/or dysgeusia without mucosa defects (gr.1 NCI-CTC) was in 4/34 (12%) patients, mucosal defects without oral intake limitation (gr.2) in 6/34 (17.5 %), mucosal defects limiting oral intake (gr.3) in 7/34 (20.5 %) patients.
Actions taken: in gr.1 EVE dose reduced to 5 mg/day in 1/4 affected patients, in gr.2 locally administered dexamethasone solution recommended in 2/6, reduction of EVE to 5 mg/day in 4/6 (in two cases the reduced dose left because of complications recurrences), in gr.3 locally administered dexamehasone solution recommended in 5/7, transient reduction of EVE to 5mg/day in 1/7, permanent reduction of EVE in 5/7 (recurrent aphthous lesions), EVE terminated in 1/7. In patients with EVE starting dose of 5mg/day there was one case (1/8, 12.5%) of gr.2 complication requiring no intervention.
The complications developed within 2-20 weeks after EVE initiation (median of 8 weeks). Conclusion: The incidence of stomatitis and its severity in this cohort is comparable with published trials data, it confirms the significant incidence of damage affecting the quality of life, oral intake and anti-cancer treatment in daily practice.
The interventions used in groups of similarly affected patients appears slightly heterogeneous, influenced by individual physician approach.