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Soreness and ulcers 5: biology, diagnosis and management of cancer regimen 2

Part 2 of 2
Published on June 29, 2017   27 min

A selection of talks on Oral Health

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0:00
Welcome to the second part of our lecture on mucositis. In this component of the lecture, we're going to talk a lot about personalized medicine, precision medicine as it applies to mucositis and toxicities in general, and a lot about how genomics can be used to accomplish that objective.
0:20
Let's talk about mTOR inhibitors a little bit. They're used very commonly now in breast cancer and patients with renal cancers. mTOR inhibitors are mammalian target of rapamycin kinase inhibitors. They work well, as I said, in renal cell cancers. They work well in patients with breast cancers. But the pathway is very complex. There are chances for error and they're
0:46
associated with a very high incidence of a form of stomatitis that is, in fact, dose limiting and treatment limiting with this group of patients. And here, you can see an example of a patient being treated for breast cancer with mTOR inhibitor-induced stomatitis. You can see that these lesions differ in their appearance from the lesions that we talked about with cytotoxic therapy. They're much more aphthous-like. There's an area of grayish necrosis surrounded by epithelium. Frequently, these lesions occur on the soft palate which makes it excruciatingly painful for patients to try to eat. So, about 40% of patients who get mTOR inhibitors now have to stop treatment or dose de-escalate. Unlike cytotoxic therapy with conventional chemotherapy, the kinetics or the trajectory of mTOR inhibitor-associated stomatitis is much more acute. Usually happens within five to seven days after treatment, and these patients when they start treatment just continually take it. They don't stop and start like patients do getting cycle chemotherapy. So, it's a big problem for these patients. And just if you take a look at this clinical image, and then look at this clinical image, which is a patient that has chemotherapy-induced mucositis, you can see how the clinical appearance is very different and unique. So, the important thing is to keep in mind that although we're talking about mucositis today primarily associated with radiation cytotoxic chemotherapy, the drug pipeline is very very robust. And what's likely to happen is that there are going to be
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Soreness and ulcers 5: biology, diagnosis and management of cancer regimen 2

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