title: Osteonecrosis of the jaws in patients assuming bisphosphonates and sunitinib: two case reports.
abstract: Osteonecrosis of the jaw (ONJ) is an unremitting adverse outcome associated with bisphosphonate therapy, primarily intravenously administered, in patients with bone metastases from solid tumors, multiple myeloma and osteometabolic diseases. From 2003 many cases of bisphosphonates related osteonecrosis of the jaw (BRONJ) have been reported in literature. Sunititnib is a novel anticancer agent used in gastrointestinal cancers and renal cancers resistant to imatinib. Recent reports describe the onset of ONJ in patients treated with both sunitinib and bisphosponates. A case of osteonecrosis of the jaw related to sunitinib, without association of bisphosphonate (BP) medications has been recently reported. A recent hypothesis suggests that antiangiogenic drugs such as sunitinib could cause ONJ even without the association with BPs. We describe a case of two patients affected by renal carcinoma under BP and sunitinib medication who developed stage III bisphosphonates-related osteonecrosis of the jaw (BRONJ).
authors.affiliation: Department of Maxillo-Facial Surgery, "Sapienza" University, Rome, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Agrillo
authors.forename: E
authors.initials: E
authors.lastname: Nastro Siniscalchi
authors.forename: A
authors.initials: A
authors.lastname: Facchini
authors.forename: F
authors.initials: F
authors.lastname: Filiaci
authors.forename: C
authors.initials: C
authors.lastname: Ungari
mesh_terms: D000368:Aged; D020533:Angiogenesis Inhibitors / Q000009:adverse effects*; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D050071:Bone Density Conservation Agents / Q000009:adverse effects*; D001859:Bone Neoplasms / Q000188:drug therapy* / Q000556:secondary; D002292:Carcinoma, Renal Cell / Q000188:drug therapy* / Q000556:secondary / Q000601:surgery; D004164:Diphosphonates / Q000009:adverse effects*; D018450:Disease Progression; D017809:Fatal Outcome; D006801:Humans; D007211:Indoles / Q000009:adverse effects*; D007680:Kidney Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D008297:Male; D009392:Nephrectomy; D011758:Pyrroles / Q000009:adverse effects*; D012307:Risk Factors; D000077210:Sunitinib; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome
chemical_list: D020533:Angiogenesis Inhibitors; D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007211:Indoles; D011758:Pyrroles; D000077210:Sunitinib