Prophylactic use of dexamethasone-based mouthwash substantially reduced the incidence and severity of stomatitis among patients with metastatic breast cancer receiving exemestane and everolimus, according to a study presented at the 2016 Palliative Care in Oncology Symposium.1

Patients receiving everolimus frequently report stomatitis, with 33% of patients treated with everolimus and exemestane reporting grade 2 or worse stomatitis in the BOLERO-2 trial. Researchers evaluated dexamethasone-based mouthwash for the prevention of stomatitis among these patients.

For the SWISH study, investigators enrolled 92 patients with hormone receptor-positive metastatic breast cancer receiving everolimus plus exemestane. Participants were instructed to use 10 mL of commercially available dexamethasone 0.5 mg/5 mL solution 4 times per day for 8 weeks beginning on day 1 of chemotherapy.

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Among the 86 evaluable patients, the rate of all grade stomatitis at 8 weeks was 21.2%, and the rate of grade 2 or worse stomatitis was 2.4%. There were no cases of grade 3 or 4 stomatitis.

Nearly 90% of patients maintained or had improved ECOG performance status and the average pain scale score was less than 1 at all visits. The same proportion of patients reported eating a normal diet at 8 weeks.

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The findings suggest that dexamethasone-based mouthwash should be considered a new standard for stomatitis prevention in this patient population.                                      


  1. Rugo HS, Beck JT, Glaspy JA, et al. Prevention of everolimus/exemestane (EVE/EXE) stomatitis in postmenopausal (PM) women with hormone receptor-positive (HR+) metastatic breast cancer (MBC) using a dexamethasone-based mouthwash (MW): Results of the SWISH trial. Poster presented at: 2016 Palliative Care in Oncology Symposium; September 9-10, 2016; San Francisco, CA.