Medication-Related Osteonecrosis of the Jaw: MASCC/ISOO/ASCO Clinical Practice Guideline

Abstract

PURPOSE To provide guidance regarding best practices in the prevention and management of medication-related osteonecrosis of the jaw (MRONJ) in patients with cancer. METHODS Multinational Association of Supportive Care in Cancer/International Society of Oral Oncology (MASCC/ISOO) and ASCO convened a multidisciplinary Expert Panel to evaluate the evidence and formulate recommendations. Guideline development involved a systematic review of the literature and a formal consensus process. PubMed and EMBASE were searched for studies of the prevention and management of MRONJ related to bone-modifying agents (BMAs) for oncologic indications published between January 2009 and December 2017. Results from an earlier systematic review (2003 to 2008) were also included. RESULTS The systematic review identified 132 publications, only 10 of which were randomized controlled trials. Recommendations underwent two rounds of consensus voting. RECOMMENDATIONS Currently, MRONJ is defined by (1) current or previous treatment with a BMA or angiogenic inhibitor, (2) exposed bone or bone that can be probed through an intraoral or extraoral fistula in the maxillofacial region and that has persisted for longer than 8 weeks, and (3) no history of radiation therapy to the jaws or metastatic disease to the jaws. In patients who initiate a BMA, preventive care includes comprehensive dental assessments, discussion of modifiable risk factors, and avoidance of elective dentoalveolar surgery (ie, surgery that involves the teeth or contiguous alveolar bone) during BMA treatment. It remains uncertain whether BMAs should be discontinued before dentoalveolar surgery. Staging of MRONJ should be performed by a clinician with experience in the management of MRONJ. Conservative measures comprise the initial approach to MRONJ treatment. Ongoing collaboration among the dentist, dental specialist, and oncologist is essential to optimal patient care.

Preventing, identifying, and managing medication-related osteonecrosis of the jaw: a practical guide for nurses and other allied healthcare professionals

“…The Multinational Association of Supportive Care in Cancer/ International Society of Oral Oncology/American Society of Clinical Oncology (MASCC/ISOO/ASCO) Clinical Practice Guideline (2019) advises on best practice in the prevention and management of MRONJ in patients with cancer, based on expert opinion and evidence from a comprehensive literature review [2]. This guidance lists risk factors for the MRONJ development; these are summarized in Table 2.…”

“…Medication-related osteonecrosis of the jaw (MRONJ) is an infrequent, but potentially serious, adverse event associated with bone-modifying agents (BMAs; principally bisphosphonates and denosumab) and antiangiogenic therapies [1][2][3]. MRONJ has also been reported with tyrosine-kinase inhibitors, mechanistic target of rapamycin inhibitors, BRAF inhibitors, immune checkpoint inhibitors, and cytotoxic chemotherapy [3].…”

Medikamenten-assoziierte Kiefernekrosen – Relevanz aus rheumatologischer Sicht?

“…Durch Mikrotraumata wird er durch die tägliche Kauaktivität belastet und die Umbaurate zur Reparatur soll dabei 10fach höher liegen als bei den anderen Extremitätenknochen. Lokale Traumata der Schleimhaut können nicht nur durch Zahnextraktionen, sondern auch durch schlecht sitzende Prothesen erfolgen, welche nach Literatur auch die häufigsten Ursachen einer MRONJ darstellen [2,10,11,12].…”

“…Dabei gilt es auch, marktote Zähne zu behandeln. Hier gibt die Leitlinie detaillierte Hinweise und Hilfestellungen, welche Zähne saniert werden sollten oder zu welchem Zeitpunkt dieses noch erfolgen kann [2,6,11].…”

“…Darstellung eines Stadiums 2. Empfehlungen bei Patienten mit oder vor Antiresorptivatherapie[2,6,11]. Unter anderem wird aus diesem Grunde der Infektion eine Schlüsselrolle in der Ätiologie der MRONJ zugeordnet[4].…”