Could the Combined Administration of Bone Antiresorptive Drug, Taxanes, and Corticosteroids Worsen Medication Related Osteonecrosis of the Jaws in Cancer Patients?

Abstract

The study presents a report of 58 metastatic cancer patients who developed osteonecrosis of the jaws after being treated with zoledronic acid and taxanes, plus corticosteroids. A retrospective analysis of data registered in the archives of two Italian osteonecrosis of the jaws treatment centers, who are based at the University of Messina and at the University of Palermo, was performed in order to study, in these patients, demographic data and characteristics such as frequency of cancer location, lines of therapy, frequency of cancer drugs, presence/absence of oral trigger, number, location, and stage of jaw osteonecrosis. It was found that the majority of patients developed advanced stages of osteonecrosis, frequently complicated with infection. It was hypothesized that the concurrent administration of chemotherapeutic agents could be eventually considered as a factor able to allow a faster worsening of the clinical manifestation through the exacerbation of soft tissue defects, due to chemotherapy drugs.

Combined Administration of Bisphosphonates, Chemotherapeutic Agents, and/or Targeted Drugs Increases the Risk for Stage 3 Medication-Related Osteonecrosis of the Jaw: A 4-Year Retrospective Study

“…Bi et al [ 21 ] reported that chemotherapeutic agents resulted in larger sequestrum and soft tissue defects in the mouse MRONJ model. Oteri et al [ 16 ] hypothesized that the concurrent administration of chemotherapeutic agents could worsen the clinical manifestation of MRONJ. On the basis of that, we designed a case-control study and demonstrated that combined administration of bisphosphonates and chemotherapeutic agents could increase the risk for stage 3 MRONJ.…”

“…However, little is known regarding whether those agents are the risk indicators of stage 3 MRONJ. Oteri et al [ 16 ] reported that chemotherapy could worsen the clinical manifestation of MRONJ. Nevertheless, the conclusion was limited due to the absence of data from a case and control study and insufficient statistical evidence.…”

Medication-Related Osteonecrosis of the Jaws and CDK4/6 Inhibitors: A Recent Association

“…Although comorbid conditions under effective control were not a risk factor predisposing for the development of MRONJ, the prevalence of comorbid conditions in MRONJ patients was evaluated in view of the average age of the cohort, and the results confirmed the increasing prevalence of multimorbidity among older adults [ 12 ]. The increasing awareness of the risk for MRONJ among patients assuming novel molecules for cancer treatment [ 13 ] and/or multiple medications with synergy effect has already been described [ 14 , 15 ]. It has been reported that the combination of bisphosphonates and antiangiogenic factors may increase the risk of MRONJ [ 16 ].…”

“Holes” in the Jaw—A Report of Two Cases of Periapical Actinomycosis

“…Medication-related osteonecrosis of the jaw (MRONJ) from chronic steroids and pomalidomide use was a diagnostic consideration for our second case. Non-infectious osteonecrosis has been associated with the use of several chronic medications, including intravenous high potency bisphosphonates, denosumab [ 17 ], corticosteroids [ 18 ], and combination of corticosteroids with taxanes and denosumab [ 19 ]. The possible association between actinomycotic osteomyelitis and MRONJ has been previously described and this could also have played a role in the development of osteomyelitis in our second patient [ 20 , 21 , 22 ].…”