Management of oral stomatitis associated with BRAFi-MEKi therapy using intralesional corticosteroid and local anesthetic: a case report

This case documents the clinical pattern of a fibrinopurulent ulcer with a hyperplastic lesion that developed after the initiation of two classes of targeted therapies acting on different components of the mitogen-activated protein kinase signaling pathway (BRAF inhibitors [BRAFi] and MEK inhibitors [MEKi]). A 66-year-old woman was diagnosed with choroidal melanoma in the right eye in 2012 and successfully treated by choroidal melanoma resection. Tumor recurrence was diagnosed 8 years later. Nivolumab and ipilimumab were prescribed, but this combination was replaced with dabrafenib-trametinib due to disease progression. A second orbital exenteration and adjuvant radiotherapy to the orbital cavity (total dose of 4,000 cGy) were performed during dabrafenib-trametinib therapy. A few months after initiating this combination, the patient reported oral discomfort and an ulcer on the dorsum of the tongue. An incisional biopsy showed only signs of inflammation. A second biopsy demonstrated the same histological pattern. Based on clinical and histopathological findings, the final diagnosis was stomatitis associated with BRAFi-MEKi therapy. An intralesional injection of triamcinolone solution combined with 2% mepivacaine was performed. One month later, 0.05% topical corticosteroid was prescribed, and the lesion completely healed after an additional month. This report describes a previously unreported clinical presentation of an oral adverse event associated with combined BRAFi-MEKi therapy. It highlights the importance of recognizing unusual oral toxicities related to targeted therapies, as well as the role of appropriate local management in controlling symptoms and allowing the continuation of oncologic treatment.

Palavras-chave: BRAF inhibitor; MEK inhibitor; Mouth diseases; Dabrafenib; Melanoma; trametinib; Adrenal cortex hormones

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