The role of dexamethasone mouthwash in preventing everolimus-related stomatitis in women with breast cancer

This study investigated the use of dexamethasone (Ozurdex) mouthwash for preventing stomatitis in patients with breast cancer(BC).  The use of dexamethasone oral solution was found to significantly reduce the incidence and severity of stomatitis.

Everolimus (Afinitor) and exemestane (Aromasin) are mTOR inhibitors used to treat advanced BC in hormone receptor (HR)-positive patients who did not response to aromatase inhibitors. These treatments block the activity of the mTOR pathway, which lead to cancer cell growth. This treatment is commonly associated with stomatitis (inflammation of the lining of the mouth), a condition associated with pain and difficulty eating. In some cases the condition can be so severe that treatment must be reduced or discontinued. Patient reports have suggested that dexamethasone mouthwash may be means of preventing and reducing the severity of stomatitis.

This study involved 85 postmenopausal women with metastatic HR-positive, HER2-negative BC.  These patients were treated with everolimus (10 mg) plus exemestane (25 mg) alongside alcohol-free dexamethasone mouthwash (10 ml) four times daily. After the first 8 weeks the use of this mouthwash became optional as stomatitis typically appears in this time frame. The results of the BOLERO-2 trial were used as a comparison.

Dexamethasone mouthwash was found to reduce the incidence of all stomatitis by 61% and the incidence of more severe cases by 91% in comparison to participants in the BOLERO-2 study.

Of the 86 patients in this study, 74% continued treatment with all 3 drugs beyond the initial 8 week period.

The study concluded that preventative use of dexamethasone mouthwash in patients undergoing treatment with everolimus and exemestane was linked to a substantial drop in the occurrence and severity of stomatitis.

The study was relatively small and relied on self-reporting from patients, meaning the results may not be fully verifiable or applicable to other patient groups. Further, the use of the BOLERO-2 group as a control may not be appropriate as this group was more heavily pre-treated than the participants of this study.

Discuss with your doctor the use of dexamethasone mouthwash as part of your treatment.