Osteonecrosis of jaw beyond antiresorptive (bone-targeted) agents: new horizons in oncology

ABSTRACT

Introduction: Osteonecrosis of the jaw (ONJ) is a clinically important, potentially painful and debilitating condition, which can affect the quality of life of cancer patients. Since 2003, ONJ appeared as a Bisphosphonate(BP)-related class effect, and the term Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) was widespread.

Areas Covered: Under discussion in this review is the fact that ONJ cases have been reported after treatment including antiangiogenic agents and other “targeted therapy”, with and without BPs. Consequently, the comprehensive term Medication-Related Osteonecrosis of the Jaw (MRONJ) has been introduced. The clinical aspects and the prognosis of ONJ associated with these new drugs are still less reported, but basing on their pharmacodynamics, they could be different from the well-known BRONJ. Accordingly, recommendations largely in use for BRONJ should be extended to these new forms, but critically applied and with respect to the individual risk assessment.

Expert Opinion: There is a high risk of underdiagnoses for ONJ due to a lack of awareness, and too much restrictive or incomplete diagnostic criteria; at the same time, with regard to ONJ associated to the new non –antiresorptive agents, described here, we observe the strong need to improve the defining of any distinguished feature in their diagnosis, prevention and therapy.

KEYWORDS:

• Osteonecrosis of the jaw (ONJ)
• Bisphosphonate
• Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ)
• denosumab
• Medication-Related Osteonecrosis of the Jaw (MRONJ)
• bevacizumab
• aflibercept
• sunitinib
• temsirolimus
• everolimus

Article highlights

• Osteonecrosis of the jaw (ONJ) cases have been reported in cancer patients after treatment including antiangiogenic agents and other ‘targeted therapy’, with and without antiresorptive drugs (bisphosphonates, denosumab).

• New patient populations are at risk of ONJ.

• The number of ONJ cases in patients treated with innovative anticancer drugs are increasing.

• There is a high risk of underestimation due to a lack of awareness, and restrictive diagnostic criteria for ONJ, especially if a frank bone exposure is missing.

• Observational study and experimental research are needed to define any distinguished feature in the diagnosis, imaging, prevention and therapy of targeted-therapy associated ONJ.

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Declaration of interests

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.