Affinitor and rash and extreme itch

[Nguyen]

Hello,

Anyone has suggestion for handling extreme itch due to Affinitor (Everolimus)?

Many thanks,

Nguyen

[Jackie07]

The article/abstract was published in March and did not mention anything about how to treat the rash ... Can you get a referral to a dermatologist?

Cancer. (http://www.ncbi.nlm.nih.gov/pubmed/22437824#) 2012 Mar 21. doi: 10.1002/cncr.27505. [Epub ahead of print]
Clinical and histopathologic characteristics of rash in cancer patients treated with mammalian target of rapamycin inhibitors.

Balagula Y (http://www.ncbi.nlm.nih.gov/pubmed?term=Balagula%20Y%5BAuthor%5D&cauthor=true&cauthor_uid=22437824), Rosen A (http://www.ncbi.nlm.nih.gov/pubmed?term=Rosen%20A%5BAuthor%5D&cauthor=true&cauthor_uid=22437824), Tan BH (http://www.ncbi.nlm.nih.gov/pubmed?term=Tan%20BH%5BAuthor%5D&cauthor=true&cauthor_uid=22437824), Busam KJ (http://www.ncbi.nlm.nih.gov/pubmed?term=Busam%20KJ%5BAuthor%5D&cauthor=true&cauthor_uid=22437824), Pulitzer MP (http://www.ncbi.nlm.nih.gov/pubmed?term=Pulitzer%20MP%5BAuthor%5D&cauthor=true&cauthor_uid=22437824), Motzer RJ (http://www.ncbi.nlm.nih.gov/pubmed?term=Motzer%20RJ%5BAuthor%5D&cauthor=true&cauthor_uid=22437824), Feldman DR (http://www.ncbi.nlm.nih.gov/pubmed?term=Feldman%20DR%5BAuthor%5D&cauthor=true&cauthor_uid=22437824), Konner JA (http://www.ncbi.nlm.nih.gov/pubmed?term=Konner%20JA%5BAuthor%5D&cauthor=true&cauthor_uid=22437824), Reidy-Lagunes D (http://www.ncbi.nlm.nih.gov/pubmed?term=Reidy-Lagunes%20D%5BAuthor%5D&cauthor=true&cauthor_uid=22437824), Myskowski PL (http://www.ncbi.nlm.nih.gov/pubmed?term=Myskowski%20PL%5BAuthor%5D&cauthor=true&cauthor_uid=22437824), Lacouture ME (http://www.ncbi.nlm.nih.gov/pubmed?term=Lacouture%20ME%5BAuthor%5D&cauthor=true&cauthor_uid=22437824).
Source

Department of Medicine, Dermatology Service, Memorial Sloan-Kettering Cancer Center, New York, New York.

Abstract

BACKGROUND:

Dermatologic adverse events stemming from anticancer therapies have become an increasingly frequent clinical problem. Inhibitors of mammalian target of rapamycin (mTOR), such as temsirolimus and everolimus, have been associated with a high rate of skin eruptions, but their clinical and histopathologic characteristics have not been explored.
METHODS:

A retrospective analysis of patients who were referred to the Dermatology Service for diagnosis and management of rash in the setting of therapy with the mTOR inhibitors everolimus and temsirolimus was performed. The parameters that were studied included the time to onset, clinical presentation at the time of dermatologic evaluation, associated symptoms, evolution, results of microbiologic studies, concomitant medications, the need for dose reduction and/or treatment interruption because of rash, and routine histopathology.
RESULTS:

In total, 13 patients were analyzed. Most rashes were mild (grade 1; 31%) and moderate (grade 2; 54%) in severity, and grade 3 rashes were observed only in 2 patients (15%). The trunk was the most frequently affected region (77%), with the scalp (23%), face (38%), neck (54%), and extremities (69%) also commonly involved. Erythematous papules and pustules constituted the predominant primary lesion morphology (62%). No unique or uniform histopathologic reaction pattern was observed. The most common reaction pattern was that of a mixed, spongiotic interface and perivascular dermatitis, which was observed in 7 of 11 patients (63%).
CONCLUSIONS:

Although mTOR inhibitors may commonly induce erythematous papules and pustules, they are associated with a spectrum of lesion morphologies and a variety of histopathologic findings. Further clinicohistologic correlation studies are needed. Cancer 2012. © 2012 American Cancer Society.

[Joanne S]

ALL, If anyone else know anything about Affinitor, please advise. Thanks!

Hello Nguyen,

How is your itchy rash??? Hope you've gotten some good relief? It is diminished or gone?

I just started Exemestane 3 days ago. I will be starting Affinitor tomorrow and I'm anxious about it.
Can you tell me what I might expect?
Were you able to drive a car when your first started taking it?

I certainly hope this message finds you feeling well and wish you continued improvement. Thanks Jo

[Nguyen]

Hello Joanne,

My wife had no problem driving while she took Exemestane and Affinitor. We tried everything and she only got a bit of relief from the itch. The main problem however were the numerous mouthsores. Finally after 1.5 monnths she couldn't tolerate the mouthsores anymore so she stopped using the Affinitor. Keep in mind that everyone is different so maybe these side effects won't be so bad for you. In fact I read most (if not all) the articles about Affinitor and it seems to be a well tolerated medicine for most people. I hope that you will be in this category.

Best wishes,

Nguyen

[Joanne S]

Thank you very much for your reply Nguyen!
My doctor also gave me some MuGard Mouth Rinse to start using several times every day. Did you wife also use this?

Best wishes to both you and your wife. Praying for her continued improvement.

[Nguyen]

She tried many different mouthwash including magic mouthwash and other anesthetic, though not MuGard. I hope this work for you.

Nguyen

[Mandamoo]

I had issues with mouth sores too - I ended up with a dose reduction - what dose are you going to take?
Prevention is the best if you can - warm salty washes frequently, good mouth hygiene, no super hot drinks.
I found I used traditional Chinese medicine to help too - boosting my immune system, reducing the severity of the sores markedly. Also a Chinese powder from watermelon was amazing on the actual sores.
When they were bad, I found orabase gel very good.
I never got a rash and found it very tolerable once I had the dose reduction.
Good luck.

[Joanne S]

Thanks to both of you for your replies!!!

NuGard (Rx) was prescribed by my oncologist at the same time Affinitor and Exemestane were prescribed. I was instructed: Use a soft toothbrush with warm water for brushing. Do not use any mouthwashes that contains Alcohol. Do not use any toothpaste that contains whitening or tartar control. Warm salt-water mouth rinsing may also be helpful. Use NuGard 5-6 times daily. Keep in mouth 1-2 minutes and do not rinse. No food or drink for one hour after each use. Avoid hot (temperature) foods, grapefruit and spicy hot foods and take small bites. Do not use dental floss unless it is part of your regular routine.

Affinitor is 10mg. I make sure I take the Affinitor with 16 ounces of water. I was wondering , How soon after starting Affinitor did you start having mouth sores?

I've been taking Affinitor for a week now. Fortunately no mouth sores so far. And no itching so far. I have severe dry mouth and chapped lips and my gums feel very sensitive and tender. I have experienced some pea-size tender pimple/cyst-like breakout on my scalp. Although I drink lots of water, my skin from head to toe is severely dehydrated and looks old, dry, wrinkled chicken like skin. It looks like my skin has aged 15 years in one week. I have had a headache for 3 days, which finally diminished yesterday. Not sure if it's related to the Affinitor-Exemestane combo or not? Though no constant, I've experienced some new minor bone pain in my head, arms, legs and hips. Of course, I continue to have same the back pain problems I had for several years.

Thank you my HER-2 friends. May God Bless You with continued improvment and wellness. Please let me know how you are doing? Hugs, Joanne