A case report of bevacizumab-related osteonecrosis of the jaw: Old problem, new culprit

Dişel, Umut; Beşen, Ali Ayberk; Özyılkan, Özgür; Er, Efsun; Canpolat, Tuba

doi:10.1016/j.oraloncology.2011.07.030

Cited by 38 publications

(32 citation statements)

References 8 publications

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“…There were 3 episodes (1 grade I and 2 grade II) of osteonecrosis among 92 patients (3.3%) . These events occurred in the lunate bone of the wrist (1 patient) and in the femoral heads (2 patients), which are unique locations as compared with the adult literature, where most osteonecrosis due to BVZ occurs in the jaw bones . All 3 children came off therapy .…”

Section: Resultsmentioning

confidence: 95%

“…39 These events occurred in the lunate bone of the wrist (1 patient) and in the femoral heads (2 patients), which are unique locations as compared with the adult literature, where most osteonecrosis due to BVZ occurs in the jaw bones. [39][40][41][42] All 3 children came off therapy. 39 One patient (1.1%) suffered a grade II vascular access-associated thromboembolism.…”

Section: Resultsmentioning

confidence: 99%

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Bevacizumab (BVZ)‐associated toxicities in children with recurrent central nervous system tumors treated with BVZ and irinotecan (CPT‐11)

Fangusaro

Gururangan

Poussaint

et al. 2013

Cancer

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Background The incidence and spectrum of acute toxicities related to the use of bevacizumab (BVZ)-containing regimens in children are largely unknown. We report on the adverse events in a recently completed large phase II trial of BVZ plus irinotecan (CPT-11) in children with recurrent central nervous system (CNS) tumors. Methods Pediatric Brain Tumor Consortium (PBTC) trial-022 evaluated the efficacy and toxicity of BVZ (10 mg/kg administered intravenously) as a single agent for 2 doses given two weeks apart and then combined with CPT-11 every 2 weeks (1 course = 4 weeks) in children with recurrent CNS tumors. Children were treated until they experienced progressive disease, unacceptable toxicity or completed up to a maximum of two years of therapy. Toxicities were graded according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) version 3.0. Patients who received at least one dose of BVZ were included for toxicity assessment. Results Between October 2006 and June 2010, 92 patients evaluable for toxicity were enrolled and received 687 treatment courses. The most common toxicities attributable to BVZ included grade I–III hypertension (38% of patients), grade I–III fatigue (30%), grade I–II epistaxis (24%) and grade I–IV proteinuria (22%). Twenty-two patients (24%) stopped therapy due to toxicity. Conclusions The combination of BVZ and CPT-11 was fairly well-tolerated, and most severe BVZ-related toxicities were rare, self-limiting and manageable.

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Section: Resultsmentioning

confidence: 95%

Section: Resultsmentioning

confidence: 99%

Bevacizumab (BVZ)‐associated toxicities in children with recurrent central nervous system tumors treated with BVZ and irinotecan (CPT‐11)

Fangusaro

Gururangan

Poussaint

et al. 2013

Cancer

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“…incidences of MRONJ in patients with bone metastases treated with zoledronic acid or denosumab are similar. 17,18 In addition, MRONJ is also associated with anticancer agents, 19 including classic chemotherapy agents, 20,21 angiogenesis inhibitors, 22 tyrosine kinase inhibitors (TKIs), 23,24 inhibitors of mammalian target of rapamycin, 25 and immunotherapeutic agents. 19,26,27 Since the early reports of MRONJ, a growing body of evidence has been published on the causes, pathophysiology, prevention, and management of this condition.…”

mentioning

confidence: 99%

Medication-related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment

Nicolatou‐Galitis

Schiødt

Mendes

et al. 2019

Oral Surgery, Oral Medicine, Oral Pathology and Oral Radiology

250

203

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Skeletal complications caused by osteoporosis or bone metastases are associated with considerable pain, increased mortality, and reduced quality of life. Furthermore, such events place a burden on health care resources. Agents that prevent bone resorption, such as bisphosphonates or denosumab, can reduce the risk of skeletal-related events and are widely used in patients with osteoporosis or bone metastases of cancer. Medication-related osteonecrosis of the jaw (MRONJ) is a rare, but potentially serious, adverse event associated with high cumulative doses of bisphosphonates or denosumab. However, MRONJ can be treated, and the likelihood of the development of this condition can be reduced through prophylactic dental care and the maintenance of good oral hygiene. Dentists, as part of a multiprofessional team, have a critical role in preventing MRONJ. This review describes the incidence and pathophysiology of MRONJ and provides guidance for dental practitioners with regard to the screening, prophylactic treatment, diagnosis, and management of patients with this condition. (Oral Surg Oral Med Oral Pathol Oral Radiol 2019;127:117À135) Medication-related osteonecrosis of the jaw (MRONJ) is an uncommon condition that can occur after exposure to agents used to prevent bone complications, such as bisphosphonates or denosumab, or treatment with other agents, such as angiogenesis inhibitors. 1 In the majority of cases, MRONJ manifests as exposed bone in the maxillofacial region (Figure 1), although non-exposed MRONJ has also been recognized (Figure 2). 2-5 Bisphosphonates and denosumab are predominantly used to reduce the risk of skeletal complications in patients with bone loss, resulting from long-term cancer treatment or osteoporosis, and in patients with malignant bone disease. 6-8 Bisphosphonates are small molecules that dock in hydroxyapatite-binding sites on bone surfaces. When osteoclasts begin to resorb bisphosphonate-impregnated bone, the liberated bisphosphonates bind to farnesyl pyrophosphate synthase inside the osteoclasts, ultimately leading to apoptosis. 8-10 Denosumab is a fully human monoclonal antibody, which has a different mode of action from that of bisphosphonates. It targets and binds to the receptor activator of nuclear factor k-B (RANK) ligand (RANKL); in doing so it prevents the activation of RANK on the surface of osteoclasts and osteoclast precursors. Inhibition of the RANKLÀRANK interaction impedes osteoclast formation, function, and survival, thereby decreasing bone resorption. 11 MRONJ is more prevalent among patients receiving high cumulative doses of bisphosphonates or denosumab than in patients who receive lower doses. 12,13 The first cases Statement of Clinical Relevance Medication-related osteonecrosis of the jaw is a rare, but potentially serious, complication of treatment with bisphosphonates and denosumab. It is important for dentists to be aware of ways to identify and treat patients at risk of this condition.

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“…VEGF inhibitors work somewhat more directly to inhibit the osteoclasts through their action on monocytes which then are in the osteoclast developmental feedback loop. Further reading on these medications will be left to the reader for exploration [30][31][32][33][34][35][36][37][38][39][40].…”

Section: History and Medication Review Of Osteochemonecrosismentioning

confidence: 99%

Osteochemonecrosis: An Overview

Hellstein

2014

Head and Neck Pathol

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A case report of bevacizumab-related osteonecrosis of the jaw: Old problem, new culprit

Cited by 38 publications

References 8 publications

Bevacizumab (BVZ)‐associated toxicities in children with recurrent central nervous system tumors treated with BVZ and irinotecan (CPT‐11)

Bevacizumab (BVZ)‐associated toxicities in children with recurrent central nervous system tumors treated with BVZ and irinotecan (CPT‐11)

Medication-related osteonecrosis of the jaw: definition and best practice for prevention, diagnosis, and treatment

Osteochemonecrosis: An Overview

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