Introduction: The rapid-onset opioid fentanyl is used to treat breakthrough pain in the management of cancer pain. Case Report: A 33-year-old woman started to receive palliative radiation for multiple spinal metastases and pathological fracture of the sacrum following surgery for right breast cancer. Although oxycodone sustained-release tablets and oxycodone powder had been used for the treatment of pain, there had been no alleviation in response to oxycodone powder at times that she experienced breakthrough pain. Therefore, the patient was switched to rapidly acting fentanyl citrate sublingual tablets. An analgesic effect was obtained, but numbness of the lower lip and taste disturbance emerged. Furthermore, pain in the lower jaw emerged and eating became difficult. Therefore, the patient was switched to fentanyl citrate buccal tablets. However, once the agents were dissolved and spread inside the mouth, the same symptoms emerged. Conclusion: Because the same symptoms were observed even after switching agents, fentanyl citrate or the common ingredient contained in both agents appeared to be the cause of this event.

Background: Everolimus is a molecularly targeted drug for renal cell carcinoma. It is also approved for pancreatic neuroendocrine tumors ("PNET") and tuberous sclerosis complex ("TSC") in Japan and frequently associated with stomatitis, one of the most common adverse reactions. However, the mechanism of the onset of stomatitis has not been elucidated, and no reports have been published on appropriate prophylaxis against everolimus-induced stomatitis. Method: In the Department of Urology, Yamagata University Hospital, gargling with sodium azulene sulfonate has been used prophylactically since October 2010, when oral treatment with everolimus was first administered at our hospital. In this study, the preventive effect of gargling with sodium azulene sulfonate on stomatitis was evaluated in 21 patients receiving everolimus. Result: The incidence of stomatitis was 53.3% (Grade 3/4: 0%) in the intervention group and 83.3% (Grade 3/4: 16.7%) in the non-intervention group; patients treated in October 2010 or earlier. The grade of severity was significantly lower in the intervention group (Median grade: 1 vs. 2, p<0.05; Mann-Whitney’s U test). However, there was no difference in the time of onset between the two groups. Discussion: Sodium azulene sulfonate effectively prevented stomatitis probably because it not only has anti-inflammatory and mucosal protective effects, but also promotes wound healing. Further detailed analysis will be required in more patients.