Veljovic Tanja, Djuric Milanko, Gusic Ivana, Vuckovic Nada, Ramic Bojana, Mirnic Jelena
Department of Dental Medicine, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia.
Dentistry Clinic of Vojvodina, Department of Dental Medicine, Faculty of Medicine, University of Novi Sad, 21000 Novi Sad, Serbia.
J Clin Med. 2024 Dec 26;14(1):65. doi: 10.3390/jcm14010065.
: Although BRAF inhibitors, such as vemurafenib, produce a marked response in patients with advanced melanoma with a BRAF V600 mutation, they eventually develop resistance to this treatment. To address this issue, vemurafenib is increasingly combined with the MEK inhibitor cobimetinib, leading to improved response rates and enhanced survival. However, this treatment modality is associated with numerous side effects. We present a case of gingival hyperplasia in a patient treated with vemurafenib, along with the strategy adopted for the management of this condition, and the impact of subsequent cobimetinib administration on its severity. : The 59-year-old male patient in the focus of this report presented at the Department of Periodontology at the Medical Faculty, University of Novi Sad, in 2019, complaining of gingival overgrowth and bleeding. The patient reported persistent gum swelling during the preceding six months, which he ascribed to the use of vemurafenib, 960 mg twice daily, since 2018, when this medication was prescribed as a part of malignant melanoma treatment. Detailed clinical examination revealed significant gingival overgrowth around all present teeth, affecting the vestibular as well as the oral sides. The patient underwent thorough scaling and root planing, followed by the surgical removal of hyperplastic gingiva. After gingivectomy, the patient was scheduled for follow-up visits at one-month intervals. Six months after gingivectomy, vemurafenib dose was reduced to 720 mg twice daily, and cobimetinib was introduced at 60 mg per day. : The treatment protocol adopted in this study, combined with cobimetinib administration, stabilized the gingiva condition in this patient. However, due to his overall poor oral hygiene, gingiva remained inflamed and edematous, but was no longer hyperplastic and hyperkeratotic in appearance. : This case underscores the importance of recognizing and adequately addressing this complication, as its adverse effect on a patient's quality of life can potentially compromise treatment protocol adherence.
尽管BRAF抑制剂（如维莫非尼）在患有BRAF V600突变的晚期黑色素瘤患者中产生显著反应，但他们最终会对这种治疗产生耐药性。为了解决这个问题，维莫非尼越来越多地与MEK抑制剂考比替尼联合使用，从而提高缓解率并延长生存期。然而，这种治疗方式伴随着许多副作用。我们报告一例接受维莫非尼治疗的患者出现牙龈增生的病例，以及针对该病症所采取的管理策略，以及随后给予考比替尼对其严重程度的影响。：本报告重点关注的这位59岁男性患者于2019年就诊于诺维萨德大学医学院牙周病科，主诉牙龈增生和出血。患者报告在过去六个月中牙龈持续肿胀，他将其归因于自2018年以来每天两次服用960毫克维莫非尼，当时该药物作为恶性黑色素瘤治疗的一部分被开出处方。详细的临床检查发现所有现存牙齿周围均有明显的牙龈增生，影响前庭侧以及口腔侧。患者接受了彻底的龈上洁治和根面平整，随后手术切除增生的牙龈。牙龈切除术后，患者被安排每月进行一次随访。牙龈切除术后六个月，维莫非尼剂量减至每天两次720毫克，并开始每天服用考比替尼60毫克。：本研究采用的治疗方案，结合考比替尼的给药，使该患者的牙龈状况稳定。然而，由于他总体口腔卫生较差，牙龈仍有炎症和水肿，但外观上不再增生和角化过度。：该病例强调了认识并充分处理这种并发症的重要性，因为其对患者生活质量的不利影响可能会潜在地影响治疗方案的依从性。
