Sunitinib related osteonecrosis of jaw: a case report

Fleissig, Yoram; Regev, Eran; Lehman, Hadas

doi:10.1016/j.tripleo.2011.06.023

Cited by 113 publications

(76 citation statements)

References 17 publications

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“…42–46 Both sunitinib and bevacizumab are antiangiogenic agents used in cancer treatment. It is estimated that BRONJ frequency is higher in patients receiving combined BP and antiangiogenic treatment compared with patients receiving BP therapy alone.…”

Section: Discussionmentioning

confidence: 99%

Serum Markers of Bone Turnover and Angiogenesis in Patients With Bisphosphonate-Related Osteonecrosis of the Jaw After Discontinuation of Long-Term Intravenous Bisphosphonate Therapy

Thumbigere‐Math

Michalowicz

Hughes

et al. 2016

Journal of Oral and Maxillofacial Surgery

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Purpose To analyze serum markers of bone turnover, angiogenesis, endocrine function, and inflammation in bisphosphonate-related osteonecrosis of the jaw (BRONJ) patients who discontinued long-term intravenous bisphosphonate (BP) therapy. Patients and Methods Serum samples were obtained from 25 BRONJ patients who had discontinued long-term intravenous BP therapy for an average of 11.4±8.7 months and 48 non-BRONJ controls who continued receiving intravenous BP therapy. Samples were analyzed for total alkaline phosphatase (ALP), bone-specific alkaline phosphatase (BALP), osteocalcin (OCN), C-telopeptide (CTX), vascular-endothelial growth factor (VEGF), triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH), 25-hydroxyvitamin D, and C-reactive protein (CRP). Results The mean number of BP infusions was significantly higher in BRONJ subjects compared with controls (38.4±26.3 infusions vs 18.8±7.2, p<0.0001); however, the duration of BP therapy was not significantly different between the groups (p=0.23). Overall, there were no significant differences in any of the markers between BRONJ subjects and controls (all p values ≥ 0.16). In a subgroup analysis that matched BRONJ subjects and controls according to mean age and BP infusions (BRONJ, n=10 and controls, n=48), log10VEGF (2.9±0.4 vs 2.4±0.4, p=<0.001) and CRP (34±26 vs 13±8, p=<0.01) levels were significantly higher in BRONJ subjects compared with controls. Within BRONJ subjects, none of the serum markers were correlated with duration of BP discontinuation. Conclusions Bone turnover and endocrine markers in BRONJ subjects who discontinue long-term intravenous BP therapy are similar to non-BRONJ controls receiving intravenous BP therapy. However, angiogenesis and inflammation markers are higher in BRONJ subjects who discontinue long-term intravenous BP therapy. The prolonged skeletal half-life of BPs may suppress bone turnover markers in BRONJ subjects for several years following discontinuation of intravenous BP therapy, suggesting an extended effect on bone homeostasis.

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Section: Discussionmentioning

confidence: 99%

Serum Markers of Bone Turnover and Angiogenesis in Patients With Bisphosphonate-Related Osteonecrosis of the Jaw After Discontinuation of Long-Term Intravenous Bisphosphonate Therapy

Thumbigere‐Math

Michalowicz

Hughes

et al. 2016

Journal of Oral and Maxillofacial Surgery

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“…Apart from bisphosphonates, other medications have been identified as a possible cause of jaw osteonecrosis. Recently, Fleissig et al (11) described a case of osteonecrosis in a 58 year old woman in the area of the right mandibular molar which had been extracted eight months before the treatment. The patient had been treated with sunitinib (antiangiogenic drug) for renal cell carcinoma.…”

Section: Raspravamentioning

confidence: 99%

Mandibular Osteonecrosis due to the Pulpal-Periodontal Syndrome: a Case Report and Review of the Literature

Gabrić

Seiwerth

Baraba

et al. 2017

Acta Stomatol Croat

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“…With the advent of new classes of medication such as denosumab, sunitinib, bevacizumab and ipilimumab (recently described in a separate report) giving rise to a similar complication (Estilo et al, 2008a; Aghaloo et al, 2010; Fleissig et al, 2012; Otto et al, 2013; Pichardo et al, 2013; O'Halloran et al, 2014; Owosho et al, 2015), the condition is now more accurately named medication-related osteonecrosis of the jaw (MRONJ), reflecting the fact that it can be caused by various medication classes (Ruggiero et al, 2014). The AAOMS 2014 position paper describes MRONJ as an area of exposed bone or probed bone either intraorally or extraorally through a fistula of greater than 8 weeks duration in a patient with a history of antiresorptive medications and no history of radiation or metastatic tumor of the jaw (Ruggiero et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Osteonecrosis of the jaw in patients treated with denosumab for metastatic tumors to the bone: A series of thirteen patients

Owosho

Blanchard

Levi

et al. 2016

Journal of Cranio-Maxillofacial Surgery

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This case series describes the course of osteonecrosis of the jaw (ONJ) in thirteen patients with metastatic bone tumors treated solely with denosumab. Patients on denosumab may be more prone to developing ONJ even without a risk/precipitating factor and they may develop ONJ early in their denosumab therapy. The outcomes of ONJ in ten patients following a period of denosumab discontinuation after the onset of ONJ were: 3 had complete resolution of symptoms, 4 patients’ ONJ progressed, 2 patients’ ONJ was unchanged and in 1 patient there was partial ONJ resolution. The role of drug discontinuation prior to an invasive dental procedure or after the onset of ONJ still remains debatable.

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Sunitinib related osteonecrosis of jaw: a case report

Cited by 113 publications

References 17 publications

Serum Markers of Bone Turnover and Angiogenesis in Patients With Bisphosphonate-Related Osteonecrosis of the Jaw After Discontinuation of Long-Term Intravenous Bisphosphonate Therapy

Serum Markers of Bone Turnover and Angiogenesis in Patients With Bisphosphonate-Related Osteonecrosis of the Jaw After Discontinuation of Long-Term Intravenous Bisphosphonate Therapy

Mandibular Osteonecrosis due to the Pulpal-Periodontal Syndrome: a Case Report and Review of the Literature

Osteonecrosis of the jaw in patients treated with denosumab for metastatic tumors to the bone: A series of thirteen patients

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