Prognosis of medication‐related osteonecrosis of the jaws in metastatic prostate cancer patients

Wei, Ling-Ying; Kok, Sang‐Heng; Lee, Yen-Ching; Chiu, Wei‐Yih; Wang, Jai-Jen; Cheng, Shih‐Jung; Chang, Hao-Hueng; Lee, Jang‐Jaer

doi:10.1111/odi.13737

Cited by 10 publications

(5 citation statements)

References 60 publications

(57 reference statements)

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“…Seven of these 10 patients who experienced ONJ resumed denosumab use after fully recovering from oral debridement. A high rate of complete ONJ remission (70.5%) after treatment was also observed in another study 25 . Two patients developed recurrent ONJ after resuming denosumab.…”

Section: Discussionsupporting

confidence: 63%

Long-term use of denosumab and its association with skeletal-related events and osteonecrosis of the jaw

Yang

Lee

et al. 2023

Sci Rep

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Denosumab, an inhibitor of receptor activator of nuclear factor kappa-B ligand, reduces skeletal-related events (SREs) and is approved for solid tumors with bone metastases. We studied long-term denosumab efficacy and safety because real-world data is scarce. This single-arm, single-center retrospective study included denosumab-treated breast cancer patients with bone metastases. Kaplan–Meier survival curves assessed exposure, SREs, osteonecrosis of the jaw (ONJ), and death. 132 patients were enrolled. The median denosumab exposure was 28.3 months (range 1.0–84.9). In the first year, 11.1% experienced SREs. This increased to 18.6% in the second, 21% in the third, and 35.1% in the fourth year and beyond. The median time to first on-study SRE has not been reached. 10 denosumab users (7.6%) developed ONJ. ONJ incidence was 0.9% in the first year, 6.2% in the second, 13.6% in the third, and 16.2% in subsequent years. The median time to first on-study ONJ has not been reached yet. Seven patients resumed denosumab after careful management of ONJ. Our data suggest that long-term treatment with denosumab may further prevent or postpone SREs at the cost of an increased risk of ONJ. The majority of patients who resumed denosumab did not experience a recurrence of ONJ.

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Section: Discussionsupporting

confidence: 63%

Long-term use of denosumab and its association with skeletal-related events and osteonecrosis of the jaw

Yang

Lee

et al. 2023

Sci Rep

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“…MRONJ occurs in patients with breast and prostate cancer treated with bisphosphonates [23,24], especially zoledronic acid [24] and with other medications for bone metastases, such as denosumab [15,25]. In the reviewed literature, compared to other bisphosphonates, zoledronic acid is responsible for most of MRONJ-type adverse effects in these patients [11].…”

Section: Discussionmentioning

confidence: 99%

Clinical and Histopathological Aspects of MRONJ in Cancer Patients

Ciobanu

Mogoantă

Camen

et al. 2023

JCM

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Medication-related osteonecrosis of the jaw (MRONJ) is a major complication of bisphosphonate treatment in cancer patients, and its etiology is not completely clarified. The study’s goal is to find connections between the clinical and histopathological characteristics of osteonecrosis and bisphosphonates in a cohort of cancer patients who had osteonecrosis treated surgically. The retrospective study includes 51 patients of both sexes, aged 46 to 85 years, who underwent surgical treatment for MRONJ in two oral and maxillofacial surgery clinics (Craiova and Constanța). Demographic, clinical, and imaging data from the records of patients with osteonecrosis were analyzed. The surgical treatment removed the necrotic bone, and the harvested fragments were analyzed from a histopathological perspective. The histopathological examination data were evaluated and statistically processed to look for viable bone, granulation tissue, bacterial colonies, and inflammatory infiltrate. In the study groups, MRONJ was found particularly in the posterior regions of the mandible. Tooth extraction, but also periapical or periodontal infections, represented the trigger factors in most of the cases. The surgical therapy consisted of sequestrectomy or bone resection, and the histopathological examination of the fragments revealed osteonecrosis-specific features, such as the lack of bone cells, the development of an inflammatory infiltrate, and the existence of bacterial colonies. MRONJ in cancer patients receiving zoledronic acid is a severe complication that significantly lowers quality of life. Since these patients are not usually monitored by the dentist, they are identified in advanced stages of MRONJ. For these patients, thorough dental monitoring could reduce the incidence of osteonecrosis and its related complications.

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“…Самые высокие коэффициенты влияния на выживаемость выявлены у пациентов с быстрым (5,11) и умеренным (2,57) ростом опухоли, у них в 5,11 и 2,57 раза выше риск смерти, чем у пациентов с медленными темпами роста опухоли.…”

Section: результатыunclassified

“…Несмотря на то что в настоящее время лучевая и лекарственная терапия являются основными методами лечения метастатического поражения костей, достаточно большое количество больных нуждаются в хирургическом лечении в связи с возникновением или угрозой патологических переломов, нестабильностью позвоночного столба и другими состояниями, если их предполагаемая продолжительность жизни составляет более 6 мес. И наоборот, некоторые пациенты с короткой продолжительностью жизни должны получать только лучевую и/или лекарственную терапию, даже если у них есть переломы или компрессия спинного мозга [3][4][5].…”

Section: Introductionunclassified

Development of a prognostic model in patients with metastatic bone lesions to choose surgical treatment: retrospective study

Bukharov¹,

Kurilchik²,

Barashev³

et al. 2023

J. Mod. Onco.

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Choosing surgical management for patients with metastatic bone lesions is one of the essential problems of modern oncology. Surgical interventions are aimed at palliative treatment in most patients with metastatic skeletal lesions. However, curative resections with reconstruction and plasty steps may be considered in selected cases of a solitary metastatic lesion. The life expectancy prognosis based on the histological structure of the tumor is a significant and decisive factor in choosing the appropriate surgery. Aim. To develop a prognostic model for choosing surgical treatment for metastatic bone lesions. Materials and methods. Treatment analysis of 715 patients with a history of surgery for metastatic bone lesions of various localizations is presented. A total of 780 surgical interventions were performed. Surgeries for the complications of bone metastases were mainly performed on the spine (48.5% of all surgeries), followed by long bones with 247 (35%) surgeries, pelvic bones with 81 (11%) interventions, and the chest wall with 40 (5.5%) surgeries. Results. The most unfavorable prognostic factors in patients with metastatic bone lesions are the histological type of the primary tumor of the rapid growth group (risk ratio [RR]=5.11), visceral metastases (RR=3.1), Charlson Comorbidity Index over 10 (RR=3.07) and presence of critical laboratory abnormalities (RR=2.91), as they have the highest rates of impact on survival (over 2.9). Conclusion. The developed 14-point mathematical score of life expectancy prognosis, which includes five oncological and four clinical factors, defines with an accuracy of 91% the risk groups of good (estimated life expectancy over one year), moderate (6 to 12 months), and poor (less than six months) prognosis in patients with metastatic bone lesions.

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Prognosis of medication‐related osteonecrosis of the jaws in metastatic prostate cancer patients

Cited by 10 publications

References 60 publications

Long-term use of denosumab and its association with skeletal-related events and osteonecrosis of the jaw

Long-term use of denosumab and its association with skeletal-related events and osteonecrosis of the jaw

Clinical and Histopathological Aspects of MRONJ in Cancer Patients

Development of a prognostic model in patients with metastatic bone lesions to choose surgical treatment: retrospective study

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