Article

Osteonecrosis of the Jaw after a Single Bisphosphonate Infusion in a Patient with Metastatic Renal Cancer Treated with Sunitinib

Academic Department of Medical Oncology, Castle Hill Hospital, Cottingham, Hull and East Yorkshire Hospitals NHS Trust, United Kingdom.
Onkologie (Impact Factor: 0.84). 01/2010; 33(6):321-3. DOI: 10.1159/000313680
Source: PubMed

ABSTRACT Osteonecrosis of the jaw (ONJ) is recognised as an important adverse effect of intravenous bisphosphonates. Recent reports have suggested that antiangiogenic agents may promote the development of this condition.
We report a case of ONJ occurring within days after the first infusion of zoledronic acid in a patient being treated with sunitinib for metastatic renal cancer. No dental procedure contributed to the occurrence of ONJ. The patient had previously experienced oral mucositis caused by sunitinib. ONJ improved with conventional oral hygiene measures, zoledronic acid discontinuation, and hyperbaric oxygen treatment.
Sunitinib-induced mucosal injury and inhibition of angiogenic signalling pathways, also involved in bone repair and remodelling, may have precipitated the phenomenon. A possible synergistic effect may need to be increasingly addressed in the clinical setting since the concomitant use of sunitinib with bisphosphonates is becoming common.

0 Followers
 · 
74 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Bone metastases are a common complication of advanced prostate cancer and while they are less common in non-prostate genitourinary (GU) malignances, they have been reported in up to 35 % of patients with advanced renal cell carcinoma and bladder cancer. Furthermore, they may occur in more than two-thirds of those patients with bladder cancer who develop distant metastases. In the absence of bone-targeted therapies, approximately 50 % of all patients with metastatic bone disease from GU cancers experience at least one skeletal-related event within their lifetime. Zoledronic acid is a bisphosphonate that has been shown to delay or prevent the development of skeletal complications in patients with bone metastases and reduce bone pain in these patients. Furthermore, zoledronic acid has also demonstrated the ability to prevent osteopenia, which may occur with the prolonged use of some pharmacological interventions in patients with cancer.
    Clinical and Translational Oncology 04/2013; DOI:10.1007/s12094-013-1033-1 · 1.60 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: PURPOSE: To investigate the efficacy and safety of zoledronic acid (ZA) combined with targeted therapy (TT). MATERIALS AND METHODS: A retrospective study was performed in patients with metastatic renal cell carcinoma treated with ZA and TT. RESULTS: Twenty-one patients received ZA and TT to prevent skeletal-related events and no pretherapy oral and maxillofacial (OM) examination (cohort A). Six patients (29%) developed osteonecrosis of the jaw (ONJ), which was observed only in patients receiving sunitinib and ZA. Sixteen patients received TT and ZA for hypercalcemia and no pretherapy OM examination (cohort B). In these patients, no ONJ was observed. Nine patients received ZA and TT and pretherapy OM examination (cohort C). One patient (11%) developed ONJ during sunitinib and ZA treatment. Mean skeletal morbidity rates were 0.8 for cohort A and 1.2 for cohort C. In the combined cohort (A plus C; n = 30), 47% developed skeletal-related events, 7% pathologic fracture, 7% medullary compression, and 37% progression of bone metastases. Patients who developed ONJ had a significantly improved median survival of 31.6 months compared with 14.5 months in patients without ONJ (P = .039). CONCLUSION: The combination of ZA and TT resulted in high, clinically meaningful activity. ONJ may be exacerbated by concomitant ZA and sunitinib. Regular OM examinations before and during treatment are recommended.
    Journal of oral and maxillofacial surgery: official journal of the American Association of Oral and Maxillofacial Surgeons 05/2013; 71(9). DOI:10.1016/j.joms.2013.03.019 · 1.28 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Strategies for management of patients with, or at risk for, Medication-Related Osteonecrosis of the Jaw (MRONJ) were set forth in the American Association of Oral and Maxillofacial Surgeons (AAOMS) Position Papers in 2007 and 2009. The Position Papers were developed by a Special Committee appointed by the Board and composed of clinicians with extensive experience in caring for these patients and basic science researchers. The knowledge base and experience in addressing MRONJ has expanded, necessitating modifications and refinements to the previous Position Paper. This Special Committee met in September 2013 to appraise the current literature and revise the guidelines as indicated to reflect current knowledge in this field. This update contains revisions to diagnosis, staging, and management strategies, and highlights current research status. AAOMS considers it vitally important that this information be disseminated to other relevant health care professionals and organizations.
    Journal of Oral and Maxillofacial Surgery 10/2014; 72(10). DOI:10.1016/j.joms.2014.04.031 · 1.28 Impact Factor