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01-02-2019 | Review Article

Osteonecrosis of the jaw related to non-antiresorptive medications: a systematic review

Authors: Ourania Nicolatou-Galitis, Maria Kouri, Erofili Papadopoulou, Emmanouil Vardas, Dimitra Galiti, Joel B. Epstein, Sharon Elad, Giuseppina Campisi, Nikolaos Tsoukalas, Kivanc Bektas-Kayhan, Winston Tan, Jean-Jacques Body, Cesar Migliorati, Rajesh V. Lalla, for the MASCC Bone Study Group

Published in: Supportive Care in Cancer | Issue 2/2019

Abstract

Introduction

The reporting of osteonecrosis of the jaw (ONJ) related to anticancer agents without known antiresorptive properties (non-antiresorptives), such as antiangiogenics, tyrosine kinase inhibitors, mammalian target of rapamycin inhibitors, immune checkpoint inhibitors, and cytotoxic chemotherapy is increasing.

Objective

To review characteristics of ONJ in cancer patients receiving non-antiresorptives.

Methods

A systematic review of the literature between 2009 and 2017 was conducted by the Bone Study Group of MASCC/ISOO.

Results

Of 6249 articles reviewed and from personal communication, 42 ONJ cases related to non-antiresorptives were identified. No gender predilection was noted. Median age was 60 years and ONJ stage 2 was most common, with predilection for posterior mandible. Exposed bone, pain, and infection were common at diagnosis. In comparison to bone targeting agents (BTAs), radiology, histology, and management were similar, with medication often discontinued. Delayed diagnosis (median 8 weeks) was noted.

Important differences included earlier time to ONJ onset (median 20 weeks), absence of trigger event (40%), and greater likelihood of healing and shorter healing time (median 8 weeks) as compared to BTA-related ONJ. Gastrointestinal cancers predominated, followed by renal cell carcinomas compared to breast, followed by prostate cancers in BTA-related ONJ, reflecting different medications.

Conclusions

Data about non-antiresorptive-related ONJ is sparse. This type of ONJ may have better prognosis compared to the BTA-related ONJ, suggested by greater likelihood of healing and shorter healing time. However, the delay in diagnosis highlights the need for more education. This is the first attempt to characterize ONJ associated with different non-antiresorptives, including BRAF and immune checkpoint inhibitors.

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Title: Osteonecrosis of the jaw related to non-antiresorptive medications: a systematic review
Authors: Ourania Nicolatou-Galitis
Maria Kouri
Erofili Papadopoulou
Emmanouil Vardas
Dimitra Galiti
Joel B. Epstein
Sharon Elad
Giuseppina Campisi
Nikolaos Tsoukalas
Kivanc Bektas-Kayhan
Winston Tan
Jean-Jacques Body
Cesar Migliorati
Rajesh V. Lalla
for the MASCC Bone Study Group
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Published in: Supportive Care in Cancer / Issue 2/2019
Print ISSN: 0941-4355
Electronic ISSN: 1433-7339
DOI: https://doi.org/10.1007/s00520-018-4501-x

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