My patient has had 2 cycles of adjuvant Nivo with worsending mouth sores and generalized mucositis. It is moderate at this time, she can drink but only eating soft foods.
I have managed quite a bit of xerstomia, and 1 case of mucositis which reversed rather quickly with supportive care. However, this patient has not responded to all supportive measures, prescription oral and oral rinse steroids. Gel clair is supporting symptoms modestly. We are going to try infliximab since this is technically a GI issue, the other consideration is mycophenolate.
What have your experiences been? any advice or guidance?
A quick update on my patient with mucositis, she received infliximab ab on 12/27, I received a fu call on 12/28 & she was already experiencing regression of swelling, sensitivity and pain. I will provided an additional update to provide time to sx resolution.
Such an interesting case. My experience with xerostomia and mucositis has been similar to your prior experience. Generally it has resolved quickly with supportive care therapies, including salt water rinses, the Biotene products, GelClair, Muguard, or decadron mouth rinses. I have also had a patient where culturing one of their ulcers did indicate a herpetic infection and the addition of an antiviral therapy seemed to help. Good to know that infliximab is also effective in this refractory case.
thanks for sharing,