Reactions 1680, p134 - 2 Dec 2017
Stomatitis, peripheral oedema and hepatic
dysfunction: case report
A 66-year-old woman developed stomatitis, peripheral
oedema and hepatic dysfunction during treatment with
The woman, who had a history of metastatic breast cancer,
was initiated on treatment with everolimus 10mg [route not
stated] after the use of chemotherapy and endocrine therapies.
There were no adverse events reported at the follow up on day
3. However, on day 11, she reported stomatitis with numerical
rating scale (NRS) of 5. Her food intake was not affected by the
stomatitis. She was initiated on glycerol [glycerin] gargles. On
day 15, she was unable to orally intake solids and her
stomatitis NRS was 9.
The woman’s everolimus was stopped. She was initiated on
azulene [sodium azulene sulfonate] gargles in addition to
glycerol. She was also started on triamcinolone [Traful direct;
triamcinolone acitonide] and vitamin B supplements [Chocola
BB plus]. On day 16, the NRS was 9 and the severity stomatitis
decreased by day 17. She had experienced a weight loss of 7 kg
but was able to eat solids by day 21 and by day 23, her
stomatitis pain had disappeared to NRS of 1.
The woman was re-initiated on everolimus 5mg along with
exemestane, after a discontinuation period of 10 days. There
was no recurrence of stomatitis; however, on 32, she
developed peripheral oedema and also it eventually worsened.
On day 57, she showed severe oedema with NRS of 8. Her
everolimus was stopped and was re-started after a follow-up.
However, she developed hepatic dysfunction on day 85. Her
everolimus and exemestane were discontinued, and she was
started on chemotherapy [not all outcome stated].
Author comment: "Many adverse events, such as
stomatitis, rash, fatigue, diarrhea, nausea and peripheral
edema, have been reported after treatment." "Therefore, it is
necessary to pay sufficient attention to adverse events caused
by everolimus after treatment initiation."
Yokoyama S, et al. Community pharmacist-led telephone follow-up enabled close
management of everolimus-induced adverse events in an outpatient with metastatic
breast cancer. Canadian Pharmacists Journal 150: 362-365, No. 6, Nov 2017 -
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