Aphthous-Like Stomatitis in a Patient Receiving Panitumumab

Panitumumab is an anti-epithelial growth factor receptor monoclonal antibody, approved for the treatment of metastatic colorectal cancer. Panitumumab has been more commonly associated with skin toxicity; oral adverse events have been scarcely reported in the literature. Herein, we present a case report of panitumumab-associated aphthous-like stomatitis.

A 58 years old female visited the Oral Oncology Unit complaining of severe oral pain. The patient had been diagnosed with colon cancer metastatic to the liver and was receiving panitumumab (every 14 days) concurrently with irinotecan and 5-fluorouracil.

Clinical examination revealed multiple aphthous-like ulcers on the ventral surface and lateral borders of the tongue, lower lip and mucolabial fold, buccal mucosa and soft palate. Dexamethasone oral solution 0.5 mg/5 ml was topically administered t.i.d. along with tramadol 50 mg per os t.i.d. for pain management. One week later, the pain was relieved and the ulcers were almost completely healed. Tramadol administration was discontinued and dexamethasone was tapered during the following 8 days. There was no need for discontinuation of panitumumab. In close follow-up for the next four months, no painful oral symptomatology was reported.

Anti-epithelial growth factor receptor agents are associated with oral adverse events that may cause severe pain, even necessitating discontinuation of the antineoplastic treatment. The implementation of preventive measures, early diagnosis, proper treatment and close monitoring of patients receiving anti-epithelial growth factor receptor agents are mandatory in order to preserve patients' quality of life and their compliance to therapeutic regimen.