Osteonecrosis of the jaw after a single bisphosphonate infusion in a patient with metastatic renal cancer treated with sunitinib.
BACKGROUND
Osteonecrosis of the jaw (ONJ) is recognised as an important adverse effect of intravenous bisphosphonates. Recent reports have suggested that antiangiogenic agents may promote the development of this condition.


METHODS
We report a case of ONJ occurring within days after the first infusion of zoledronic acid in a patient being treated with sunitinib for metastatic renal cancer. No dental procedure contributed to the occurrence of ONJ. The patient had previously experienced oral mucositis caused by sunitinib. ONJ improved with conventional oral hygiene measures, zoledronic acid discontinuation, and hyperbaric oxygen treatment.


CONCLUSIONS
Sunitinib-induced mucosal injury and inhibition of angiogenic signalling pathways, also involved in bone repair and remodelling, may have precipitated the phenomenon. A possible synergistic effect may need to be increasingly addressed in the clinical setting since the concomitant use of sunitinib with bisphosphonates is becoming common.
Academic Department of Medical Oncology, Castle Hill Hospital, Cottingham, Hull and East Yorkshire Hospitals NHS Trust, United Kingdom. geothb@yahoo.gr
George
G
Bozas
Anu
A
Roy
Vani
V
Ramasamy
Anthony
A
Maraveyas
D000970:Antineoplastic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000627:therapeutic use; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary*; D017024:Chemotherapy, Adjuvant; D003131:Combined Modality Therapy; D004164:Diphosphonates / Q000008:administration & dosage / Q000009:adverse effects*; D004357:Drug Synergism; D006801:Humans; D007093:Imidazoles / Q000008:administration & dosage / Q000009:adverse effects*; D007211:Indoles / Q000008:administration & dosage / Q000009:adverse effects*; D007262:Infusions, Intravenous; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008336:Mandibular Diseases / Q000139:chemically induced*; D008875:Middle Aged; D009367:Neoplasm Staging; D010020:Osteonecrosis / Q000139:chemically induced*; D011758:Pyrroles / Q000008:administration & dosage / Q000009:adverse effects*; D012447:Sacrum; D013125:Spinal Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000556:secondary*; D000077210:Sunitinib; D000077211:Zoledronic Acid
D000970:Antineoplastic Agents; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D007211:Indoles; D011758:Pyrroles; D000077211:Zoledronic Acid; D000077210:Sunitinib