Osteonecrosis of the Jaw in Patients With Metastatic Renal Cell Cancer Treated With Bisphosphonates and Targeted Agents: Results of an Italian Multicenter Study and Review of the Literature

Fusco, Vittorio; Porta, Camillo; Saia, Giorgia; Paglino, Chiara; Bettini, Giordana; Scoletta, Matteo; Bonacina, Riccardo; Vescovi, Paolo; Merigo, Elisabetta; Re, Giovanni Lo; Guglielmini, Pamela; Fede, Olga Di; Campisi, Giuseppina; Bedogni, Alberto

doi:10.1016/j.clgc.2014.12.002

Cited by 40 publications

(45 citation statements)

References 55 publications

(68 reference statements)

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“…[89] 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).…”

Section: Sunitinibmentioning

confidence: 99%

“…Sorafenib treatment was present, as only targeted therapy or in sequence with others, in the treatment history of RCC patients also receiving BPs. [67,69] One case report has been published about MRONJ observed in a patient with medullary thyroid cancer treated with cabozantinib without BP treatment history [91]; three ONJ cases had been reported in the original pivotal trial by Elisei et al, [92] but data about eventual BP treatment are missing.…”

Section: Other Tkismentioning

confidence: 99%

“…Italian authors collected 44 cases of ONJ with different combinations of BP and targeted agents. [67] Further literature data seem to strengthen the role of the association of antiresorptives and antiangiogenics in determining ONJ in RCC patients.…”

Section: Association Of Antingiogenic Drugs and Antiresorptive Agentsmentioning

confidence: 99%

“…Recent reports have suggested a relatively high ONJ risk in RCC patients after a combination of BPs (mostly zoledronic acid) and antiangiogenic agents (mostly sunitinib). [13,[67][68][69] Bozas and co-workers [68] identified 5 ONJ cases out of 21 RCC patients, who were treated with a combination of BPs and antiangiogenic drugs (23.8%), with a cumulative hazard ratio for ONJ of 5% (95% confidence interval [CI], 0-10%) and 36% (95% CI, 23-49%) after 12 and 24 months of treatment with zoledronate, respectively. The authors' conclusion suggests a potential synergy of sunitinib and zoledronic acid in inducing ONJ.…”

Section: Association Of Antingiogenic Drugs and Antiresorptive Agentsmentioning

confidence: 99%

“…[66] Few ONJ cases in RCC patients were described after that period. [67] Recently, treatment and prognosis of most metastatic RCC patients have improved, thanks to availability of seven innovative agents: an anti-VEGF monoclonal antibody (bevacizumab), four TKIs, i.e. sorafenib, sunitinib, pazopanib, and axitinib, and two mTOR inhibitors, i.e.…”

Section: Association Of Antingiogenic Drugs and Antiresorptive Agentsmentioning

confidence: 99%

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Osteonecrosis of jaw beyond antiresorptive (bone-targeted) agents: new horizons in oncology

Fusco

Santini

Armento

et al. 2016

Expert Opinion on Drug Safety

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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

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Section: Sunitinibmentioning

confidence: 99%

Section: Other Tkismentioning

confidence: 99%

Section: Association Of Antingiogenic Drugs and Antiresorptive Agentsmentioning

confidence: 99%

Section: Association Of Antingiogenic Drugs and Antiresorptive Agentsmentioning

confidence: 99%

Section: Association Of Antingiogenic Drugs and Antiresorptive Agentsmentioning

confidence: 99%

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Osteonecrosis of jaw beyond antiresorptive (bone-targeted) agents: new horizons in oncology

Fusco

Santini

Armento

et al. 2016

Expert Opinion on Drug Safety

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Author's Reply to: Osimertinib and jaw osteonecrosis? A case report

Luo

Zhang

2019

Intl Journal of Cancer

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Risk factors of medication‐related osteonecrosis of the jaw in preventive tooth extraction before bone resorption inhibitor administration: A multicenter nested case–control study

Saito

Nishikawa

Hara-Saito

et al. 2021

Oral Science International

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Introduction Medication‐related osteonecrosis of the jaw (MRONJ) occurs even after teeth with poor prognosis had been preventively extracted and medication had been initiated. In this nested case–control study, we focused on tooth extraction before bone resorption inhibitor administration for the treatment of malignant tumors. Materials and Methods A total of 180 teeth of 58 patients who were treated with zoledronic acid and/or denosumab from April 2012 to December 2016 at our hospital or partner institutions were included in this multicenter study. All participants underwent tooth extraction within 1 year before initiating therapy and were followed up for at least 1 year or at most 3 years after initiating bone resorption inhibitor administration. We evaluated the systemic and local risk factors: sex, age, cancer type, overweightness/obesity, anemia, undernutrition, diabetes, smoking, concomitant drugs, tooth extraction site, use of antibacterial drugs, wound closure, and waiting period between tooth extraction and medication. Results MRONJ occurred in 18 teeth of 10 patients and not in 162 teeth of 48 patients. Based on the Cox proportional hazards model, concomitant administration of angiogenesis inhibitors, mandibular molar, periapical radiolucency, and osteosclerosis of the surrounding areas were considered essential risk factors for MRONJ. Conclusions Chronic inflammation of the bone surrounding extracted teeth may be an essential risk factor for MRONJ when preventive tooth extraction is performed before the administration of bone resorption inhibitors for patients with malignant tumors.

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Osteonecrosis of the Jaw in Patients With Metastatic Renal Cell Cancer Treated With Bisphosphonates and Targeted Agents: Results of an Italian Multicenter Study and Review of the Literature

Cited by 40 publications

References 55 publications

Osteonecrosis of jaw beyond antiresorptive (bone-targeted) agents: new horizons in oncology

Osteonecrosis of jaw beyond antiresorptive (bone-targeted) agents: new horizons in oncology

Author's Reply to: Osimertinib and jaw osteonecrosis? A case report

Risk factors of medication‐related osteonecrosis of the jaw in preventive tooth extraction before bone resorption inhibitor administration: A multicenter nested case–control study

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