[Oral toxicity of targeted anticancer therapies]. / Toxicité endobuccale des thérapies ciblées anticancéreuses.

While toxicity of targeted anticancer therapies on the oral mucosa seems relatively frequent in clinical practice, it has not been properly characterized to date, apart from aphthous-like lesions due to mTOR inhibitors. Herein, we report the main oral lesions associated with these new therapies, with a description of the most frequent but also the most characteristic clinical manifestations of these drugs, such as anti-EGFR-induced mucositis, BRAF-inhibitor-associated hyperkeratosis, benign migratory glossitis and osteonecrosis of the jaw observed with angiogenesis inhibitors, as well as lesions more specifically linked with imatinib.

Geographic tongue and tenofovir.

A 55-year-old male patient with chronic hepatitis B was started on tenofovir. One month after initiating the new medication, he developed severe symptomatology with odynophagia and a very painful tongue. The physical examination reveals multiple erythematous patches on his tongue and a biopsy was performed. It allowed the diagnosis of benign migratory glossitis or geographic tongue. The patient was kept on tenofovir, but had to start topical corticoid therapy. Geographic tongue is a common condition that may be caused by drug idiosyncrasy, but has never before been associated to tenofovir. It is usually asymptomatic, but sometimes it causes severe symptoms, being an important impairment of quality of life.

Geographic tongue during a year of oral contraceptive cycles.

The geographic tongue of a 23-year-old female student was examined daily for one year. The size, number and location of the lesions were recorded using transparent films. The phase of the oral contraceptive cycle appeared to have a marked effect on the initiation and duration of the circinate lesions, the tongue changes being severest on the 17th day of the cycle. There was a positive correlation between the subjective complaint and the clinical picture of the tongue.

PIP: The number, location and extent of tongue lesions in a 23-year old woman with a tongue disorder called geographic tongue, who was taking the oral contraceptive Marvelon (Organon), were plotted for a year by tracing them daily on transparent film marked with a grid. These lesions appear as desquamation of the filiform papillae forming smooth erythematous patches with elevated white edges, occurring in multiple zones. They often heal on one border while extending on another, hence the apparent migration or "geographic" distribution. The woman developed 123 new lesions during the study period, having only 34 asymptomatic days. Her lesions lasted 1-46 days, with a mean of 7.2 days. there were an average of 2.3 lesions at a time, ranging from 0-8. Lesions developing during the 1st quarter of the oral contraceptive cycle lasted significantly longer than those appearing at other times. The total number of lesions peaked on the 17th day of the pill cycle. Subjective symptoms also were at their maximum on days 16-20 of the cycle. The woman's lesions were typical of previously reported cases: they were usually located on the anterior two-thirds of the dorsal surface, or lateral surface of the tongue. Other family members had experienced this disorder. It was concluded that pill hormones may have influenced the patient's inflammatory response. This is the 1st published association of geographic tongue with oral contraceptive intake.