Medications, without antiresorptive properties, were related to osteonecrosis of the jaw, in cancer patients
Medications, which target and protect the bone from complications of metastasis, have been related with osteonecrosis of the jaw, a potentially serious lesion. The concurrent use of those medications with targeted therapies, mainly inhibitors of angiogenesis, according to a study, may increase the risk of osteonecrosis development. Other studies showed that osteonecrosis may develop earlier when inhibitors of angiogenesis are concurrently administered with the bone targeting agents.
In a systematic review of 6,249 articles, under the scientific responsibility of the Chair of the Bone and Musculoskeletal Study Group of the Multinational Association of Supportive Care in Cancer, Professor Ourania Nicolatou-Galitis, 42 cases of osteonecrosis were related to the administration of targeted therapies, without concurrent use of bone targeting agents.
Clinical characteristics and delay in diagnosis
Exposed, necrotic bone, pain and infection were the main symptoms at diagnosis, while a median delay of 8 weeks to diagnosis was reported.
Differences from the osteonecrosis related to bone targeting agents
Important differences were observed related to the earlier time to osteonecrosis development, absence of trigger event, and greater likelihood of healing and shorter healing time (median 8 weeks). Gastrointestinal cancers predominated, followed by renal cell carcinomas compared to breast, followed by prostate cancers in the osteonecrosis related to bone targeting agents.
This type of osteonecrosis may have better prognosis compared to the osteonecrosis related to bone targeting agents, suggested by greater likelihood of healing and shorter healing time. However, the delay in diagnosis highlights the need for more education.
The maintenance of good oral hygiene and the information and education of patients and doctors, aiming to early diagnosis will result to a successful management and clinical outcome.
Data about non-antiresorptive-related ONJ is sparse. This review is the first attempt to determine the characteristics, including the radiological and histological features, of osteonecrosis of the jaw related to the collective term of «non-antiresorptives».
Nicolatou-Galitis et al, for the MASCC Bone Study Group (2019). Osteonecrosis of the jaw related to non-antiresorptive medications: a systematic review. Supportive Care in Cancer 27:383-394.