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

ArticleinOnkologie 33(6):321-3 · June 2010with15 Reads
DOI: 10.1159/000313680 · Source: PubMed
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.
    • "Besides initial reports of patients also treated with BPs,[10,55,56,58,62,90] sunitinib appeared as the only agent administered in some RCC patients suffering of ONJ [59][60][61]Furthermore, sunitinib was associated to BPs in numerous ONJ cases in RCC population, [67] with an incidence higher than expected when a denominator was reported. [13,57,69] However, Smidt-Hansen reported the possibility of decreasing the ONJ risk after adopting preventive measures (as well as recommended in general BP-treated population). "
    [Show abstract] [Hide abstract] ABSTRACT: Introduction: Osteonecrosis of the jaw (ONJ) is a clinically important, potentially painful and debilitating condition, which can affect the quality of life of cancer patients. Since 2003, ONJ appeared as a Bisphosphonate(BP)-related class effect, and the term Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) was widespread. Areas Covered: Under discussion in this review is the fact that ONJ cases have been reported after treatment including antiangiogenic agents and other "targeted therapy", with and without BPs. Consequently, the comprehensive term Medication-Related Osteonecrosis of the Jaw (MRONJ) has been introduced. The clinical aspects and the prognosis of ONJ associated with these new drugs are still less reported, but basing on their pharmacodynamics, they could be different from the well-known BRONJ. Accordingly, recommendations largely in use for BRONJ should be extended to these new forms, but critically applied and with respect to the individual risk assessment. Expert Opinion: There is a high risk of underdiagnoses for ONJ due to a lack of awareness, and too much restrictive or incomplete diagnostic criteria; at the same time, with regard to ONJ associated to the new non -antiresorptive agents, described here, we observe the strong need to improve the defining of any distinguished feature in their diagnosis, prevention and therapy.
    Full-text · Article · Apr 2016
    • "Duration of treatment is a risk factor contributing to the development of BP-ONJ lesions regardless of therapy indications [29]. We know of only one case report of a patient with metastatic renal cancer treated with sunitinib who suffered from spontaneous exposed bone after a single infusion of ZOL [32]. It is discussed that sunitinib as inhibitor of VEGF-R2 and PDGF-Rbeta tyrosine kinase and therefore angiogenesis increases the risk for ONJ and in very rare cases may induce necrosis without additional antiresorptive treatment . "
    [Show abstract] [Hide abstract] ABSTRACT: Bisphosphonate-related osteonecrosis of the jaw (BP-ONJ) occurs in 1 % of patients with medication-induced osteoporosis treated with bisphosphonates. Sheep are an established large animal model for investigating osteoporotic skeletal changes. Zoledronate significantly reduces tissue mineral variability in ovariectomized sheep. The aim of this study was to analyze bone healing after tooth extraction in sheep with induced osteopenia and zoledronate administration. Eight adult ewes were randomly divided into two groups of four animals. All sheep underwent ovariectomy and a low-calcium diet. Dexamethasone was administered weekly for 16 weeks. Zoledronate was then given every third week for a further 16 weeks in four sheep; these infusions were repeated after extraction of two lower premolars. Four sheep without zoledronate administrations served as controls. Due to general health conditions, two sheep of the zoledronate group had to be excluded before surgery. The remaining two sheep of this group developed BP-ONJ lesions at the extraction site and various other sites in both jaws. Control group animals showed uneventful wound healing. Histology of the alveolar processes as well as lumbar spine revealed larger portions of old bone and smaller portions of new bone in the zoledronate group. This animal study showed uneventful wound healing after tooth extraction in osteopenic sheep whereas zoledronate treatment leads to development of BP-ONJ-like lesions. As bisphosphonate administration is a standard treatment for glucocorticoid-induced osteoporosis, this model can be used for further research in pathogenesis and management of bisphosphonate-related adverse events.
    Full-text · Article · Apr 2015
    • "@BULLET ceux liés à la réalisation d'actes de chirurgie dentaire invasifs tels que les extractions dentaires mais aussi les résections apicales, les actes implantaires, etc. [22,6667686970717273. Des études montrent que les actes chirurgicaux (dentaires ou maxillo-faciaux) seraient le facteur déclenchant d'une ONM dans 50 à 88 % des cas74757677. Ceci signifie cependant qu'environ 20 à 26 % des ONM apparaissent de manière spontanée [29, 67, 78]. Il s'agit d'un facteur de risque ponctuel, c'est-à-dire qu'un acte chirurgical va augmenter brutalement le risque de survenue d'une ONM en le multipliant en moyenne par 7 [9, 66] (de 5,3 à 21 selon les études [70, 77, 79, 80]). "
    Full-text · Article · Apr 2013
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