Recurrent submandibular fistula after Sunitinib treatment in a patient with renal cell carcinoma: a case report

Abstract

Sunitinib is commonly used in the treatment of patients with renal cell carcinoma and is associated with serious side-effects. We present the first report of a recurrent submandibular fistula in a patient treated with sunitinib. A 68-year-old man was referred to our clinic for a cutaneous fistula situated on the right side of his lower jaw. The patient had been diagnosed with bone metastases from a renal carcinoma 2 years ago and had received a single 4 mg dose of zoledronic acid and subsequent treatment with sunitinib 37.5 mg once daily for the past 4 weeks. The patient was treated surgically by a perilesional incision and primary closure with sutures, advised on meticulous oral hygiene and was kept on an antimicrobial agent in the form of clindamycin. After reinitiating his oncological treatment with sunitinib the cutaneous fistula re-appeared and bone abnormalities were also detected on his X-ray. After 18 months a contralateral cutaneous fistula was observed along with a spontaneous avulsion of the patient’s left molar. Repeat surgical treatment and sequestrectomy was performed with the subsequent histopathological examination revealing a suspicion of osteonecrosis of the jaw and an associated Actinomyces infection.

Exploring the Impact of Novel Anti-Cancer Therapies on Jaw Osteonecrosis and Other Bones: A Comprehensive Review

“…VEGF also contributes to the function of osteoclast cells, and blocking this factor could shed light on the underlying mechanisms that heighten the risk of ONJ in patients treated with sunitinib [39]. There is large number of reports on ONJ after sunitinib treatment [40][41][42][43][44][45][46][47][48][49]. Vallina et al [50] conducted a systematic review of reports involving 102 patients treated with sunitinib, of which 58 (56.86%) developed ONJ.…”

Resemblances and differences between osteoradionecrosis of the jaw and medication-related osteonecrosis of the jaw

“…Another drug related to the appearance of osteonecrosis is sunitinib, a multi-targeted tyrosine kinase receptor inhibitor with a potent anti-tumor effect [ 8 . 9 ]. Subsequently, the notion of Medication-Related Osteonecrosis of the Jaw (MRONJ) was defined to include bisphosphonate, denosumab, or other antiresorptive or angiogenetic drugs causing this complication.…”