Drug holiday of high-dose denosumab and recovery from osteoclast inhibition using immunohistochemical investigation of 7 patients with medication-related osteonecrosis of the jaw undergoing segmental mandibulectomy

Sawada, Shunsuke; Sakamoto, Yuki; Kirihigashi, Mako; Kojima, Yasuyuki

doi:10.1016/j.jds.2023.01.021

Cited by 1 publication

(1 citation statement)

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“…Nevertheless, there are some studies that do not suggest a Denosumab drug holiday in cancer patients because of the increased risk of disease progression [64,65,68]. On the other hand, there is a case series that suggests Denosumab suspension 12 months prior to any surgical procedures [69]. Thus, the authors considered the 2022 AAOMS position paper as guidelines, which suggests a Denosumab drug holiday of 3-4 months, due to the insignificant levels of osteoclast inhibition after that period [1].…”

Section: Case Discussionmentioning

confidence: 99%

Could MRONJ Be Related to Osimertinib Monotherapy in Lung Cancer Patients after Denosumab Suspension?

Forte,

d’Amati,

Limongelli

et al. 2024

Healthcare

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Background: Medication-related osteonecrosis of the jaws is the most frequent complication in patients treated or in therapy with antiresorptive/antiangiogenetic drugs. The list of medications possibly related to MRONJ onset is constantly growing; we aimed to report on a third-generation epidermal growth factor receptor tyrosine kinase inhibitor (Osimertinib) as possibly responsible for bilateral maxillary necrosis onset in the herein-described case. Methods: In June 2023, an oncologic patient with two different maxillary bone exposures was referred to our attention. His medical history revealed a two-year Denosumab regimen along with Osimertinib, the latter not suspended before teeth extractions. The clinicians performed a sequestrum removal and bone debridement after three cycles of antibiotic therapy. Results: Histologic examinations confirmed the clinical diagnosis of MRONJ excluding a metastatic occurrence, while complete mucosal healing was achieved after 15 days. Conclusions: The patient suspended Denosumab for more than six months before teeth extraction for MRONJ prevention; hence, failure to discontinue Osimertinib led us to consider it a possible etiological factor. From a literature analysis, only one case has already been published reporting a possible Osimertinib-related occurrence of MRONJ in lung cancer patients. Our case is a further report that could be intended as an alert both for oncologists and dentists to share decisions about the oral management of such patients together, also informing them about this possible risk. Also, this report could trigger in the scientific community the necessity to evaluate further guidelines for similar doubtful cases in which the drug interaction, the mono-suspension, and the possible removable prosthesis-related additional trauma should be considered causes or con-causes.

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