title: Osteonecrosis of the jaw in patients with cancer who received zoledronic acid and bevacizumab.
abstract: BACKGROUND
  The authors investigated the incidence of and risk factors for osteonecrosis of the jaw (ONJ) in patients with metastases to the bone who received the bisphosphonate agent zoledronic acid (ZOL) and chemotherapy combined with the antiangiogenic agent bevacizumab (BEV).
  
  
  METHODS
  The authors evaluated 59 participants (34 with breast cancer and 25 with nonsmall-cell lung cancer). All of the participants received 4 milligrams of ZOL via intravenous (IV) infusion every four weeks and 15 mg per kilogram of BEV every three weeks. They conducted a dental examination in participants at baseline and every three months until the patients died or were lost to follow-up. If needed, participants received periodontal disease treatment and underwent tooth extraction before they started receiving ZOL and BEV.
  
  
  RESULTS
  The median time the participants received ZOL therapy was 18.8 months (range, 3.1-28.9 months); 36 participants (61.0 percent) received ZOL therapy for more than one year. The median time participants received BEV therapy was 16.7 months (range, 2.8-29.6 months). None of the participants required dentoalveolar surgery while undergoing cancer treatment. After a median follow-up period of 19.7 months, none of the participants developed bisphosphonate-related ONJ.
  
  
  CONCLUSIONS
  ZOL combined with BEV did not predispose to ONJ participants with cancer that had metastasized to the bone who underwent a baseline dental examination and preventive dental measures. The study results must be considered in the context of the study's protocols and the follow-up period.
authors.affiliation: Department of Odontostomatology and Maxillo-Facial Surgery, University of Siena, Italy.
authors.forename: Filippo
authors.initials: F
authors.lastname: Francini
authors.forename: Alessandra
authors.initials: A
authors.lastname: Pascucci
authors.forename: Edoardo
authors.initials: E
authors.lastname: Francini
authors.forename: Salvatora Tindara
authors.initials: ST
authors.lastname: Miano
authors.forename: Gianluca
authors.initials: G
authors.lastname: Bargagli
authors.forename: Grazia
authors.initials: G
authors.lastname: Ruggiero
authors.forename: Roberto
authors.initials: R
authors.lastname: Petrioli
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020533:Angiogenesis Inhibitors / Q000627:therapeutic use*; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D061067:Antibodies, Monoclonal, Humanized; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D000068258:Bevacizumab; D015415:Biomarkers / Q000097:blood; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D001859:Bone Neoplasms / Q000188:drug therapy / Q000556:secondary*; D001943:Breast Neoplasms / Q000473:pathology; D002289:Carcinoma, Non-Small-Cell Lung / Q000473:pathology; D024042:Collagen Type I / Q000097:blood; D003729:Dental Care; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007093:Imidazoles / Q000627:therapeutic use*; D007571:Jaw Diseases / Q000209:etiology*; D008175:Lung Neoplasms / Q000473:pathology; D008297:Male; D008875:Middle Aged; D010020:Osteonecrosis / Q000209:etiology*; D010455:Peptides / Q000097:blood; D010510:Periodontal Diseases / Q000628:therapy; D011862:Radiography, Panoramic; D012307:Risk Factors; D014081:Tooth Extraction; D000077211:Zoledronic Acid
chemical_list: D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D015415:Biomarkers; D050071:Bone Density Conservation Agents; D024042:Collagen Type I; D004164:Diphosphonates; D007093:Imidazoles; D010455:Peptides; C052929:collagen type I trimeric cross-linked peptide; D000068258:Bevacizumab; D000077211:Zoledronic Acid