Reduction of osteonecrosis of the jaw (ONJ) after implementation of preventive measures in patients with multiple myeloma treated with zoledronic acid

Dimopoulos, Meletios Α.; Kastritis, Efstathios; Bamia, Christina; Melakopoulos, Ioannis; Gika, Dimitra; Ρούσσου, Μαρία; Migkou, Magdalini; Eleftherakis-Papaiakovou, Evangelos; Christoulas, Dimitrios; Terpos, Evangelos; Bamias, Aristotle

doi:10.1093/annonc/mdn554

Cited by 368 publications

(245 citation statements)

References 17 publications

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“…Sufficient evidence is available to indicate the efficacy of BPPs in patients with bone metastasis (Wog and Wiffen., 2002). However, BPPs should not be considered as alternatives to analgesic treatment, and should be initiated after the resolution of dental problems, if possible (Dimopoulos et al, 2009;). …”

Section: Roles Of Radiotherapy Radioisotopes and Bisphosphonatesmentioning

confidence: 99%

Cancer Pain Prevalence and its Management

Arslan¹,

Koca²,

Akar³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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Pain is a public health problem affecting more than half of cancer patients. Despite the success of the protocols currently used, pain cannot still be reduced satisfactorily in the large majority of patients. In order to improve pain management, all healthcare professionals involved with pain should have sufficient knowledge on pain assessment and treatment, and should inform patients to prevent patient-related barriers. In this compilation, the prevalence values and the treatment methods of cancer pain, and the barriers to pain management have been assessed.

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Section: Roles Of Radiotherapy Radioisotopes and Bisphosphonatesmentioning

confidence: 99%

Cancer Pain Prevalence and its Management

Arslan¹,

Koca²,

Akar³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…These results are consistent with the low incidence of ONJ in patients continuing with monthly ZOL in recent long‐term studies (≤5%) and in studies implementing the new safety guidelines (≤6.7%) (Dimopoulos et al., 2009; Gnant et al., 2011; Morgan et al., 2012; Ripamonti et al., 2009). Among patients with MM who received ZOL treatment before preventive dental measures, in one study ( n = 38), the incidence of ONJ (albeit not adjudicated) was 26% (Dimopoulos et al., 2009). Thus, prevention of ONJ during bisphosphonate treatment appears effective with these guidelines.…”

Section: Discussionmentioning

confidence: 99%

Long-term safety of monthly zoledronic acid therapy beyond 1 year in patients with advanced cancer involving bone (LoTESS): A multicentre prospective phase 4 study

Khalafallah

Slancar²,

Cosolo³

et al. 2017

Eur J Cancer Care

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Malignant bone disease can cause significant morbidity. Monthly zoledronic acid (ZOL) reduces skeletal complications; however, limited data are available regarding long‐term safety. We aimed to assess efficacy and safety of ZOL beyond 1 year of treatment. We prospectively evaluated 73 patients; breast cancer (n = 29), castrate‐resistant prostate cancer (n = 13), multiple myeloma (n = 31) from 2006 to 2008 in 19 cancer centres. All patients were diagnosed with bone disease and had completed 1–2 years of monthly ZOL (4 mg) and received a further 1–2 years of therapy following contemporary guidelines for managing risks of osteonecrosis of the jaw (ONJ) and renal toxicity. Overall rates of skeletal‐related events (SREs), renal impairment and ONJ were assessed. Over the additional 1 year of treatment, only 5.5% (n = 4) of patients developed a new SRE. The overall Kaplan–Meier estimate for SRE incidence after 48 weeks on study was 6.75% (95 CI: 2.5–17.3). Although 51% of patients reported serious adverse events, only two cases were suspected as ZOL related. No patients had confirmed ONJ. The observed incidence of new renal impairment was 11% (none due to ZOL). Our study confirms the benefit over risk of continuing monthly ZOL for at least 2 years in patients with advanced cancer involving bone.

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“…The approach to MRONJ should be multidisciplinary and include an appropriated dental evaluation before initiating the antiresorptive or antiangiogenic to reduce local risk factors (5,(14)(15)(16)(17)(18). Whenever MRONJ cannot be avoided, local treatment consists in eliminating the pain and control local infection.…”

Section: Mronj Was First Reported In 2003 But Its Pathophysiologymentioning

confidence: 99%

Surgery Combined with LPRF in Denosumab Osteonecrosis of the Jaw: Case Report

et al. 2016

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This paper describes two cases in which the use of leucocyte-rich and platelet-rich fibrin (LPRF) combined with bone resection did not result in complete tissue response in the treatment of medication-related osteonecrosis of the jaw (MRONJ). It has been recently described in patients receiving subcutaneous administration of RANK-inhibitors, such as Denosumab, and anti-angiogenic drugs, such as Bevacizumab, as observed in our cases. Due to promising results in recent studies, more patients will receive these medications in order to avoid skeletal complications due to metastatic bone disease and, therefore, this scenario has a potential to become a comparable challenge to the bisphosphonateinduced jaw necrosis in the area of Oral and Maxillofacial Surgery. No convincing surgical technique has been described to overcome the non-healing mucosal lesions with exposed bone due to RANK-inhibitor therapy. Based on the findings in the literature and in both cases described herein can be concluded that the use of LPRF should be considered in the treatment of patients with DRONJ. S u r g e r y C o m b i n e d w i t h L P R F i n D e n o s u m a b O s t e o n e c r o s i s o f t h e J a w : C a s e R e p o r t

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Reduction of osteonecrosis of the jaw (ONJ) after implementation of preventive measures in patients with multiple myeloma treated with zoledronic acid

Abstract: In conclusion, the risk of developing ONJ after treatment of zoledronic acid is reduced (but not deleted) by the implementation of preventive measures.

Cited by 368 publications

References 17 publications

Cancer Pain Prevalence and its Management

Cancer Pain Prevalence and its Management

Long-term safety of monthly zoledronic acid therapy beyond 1 year in patients with advanced cancer involving bone (LoTESS): A multicentre prospective phase 4 study

Surgery Combined with LPRF in Denosumab Osteonecrosis of the Jaw: Case Report

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