title: Osteonecrosis of the jaw in a patient receiving cabozantinib.
abstract: Since the discovery of bisphosphonate-related osteonecrosis of the jaw, there has been increasing evidence in recent years of osteonecrosis induced by drugs other than bisphosphonates, mainly agents with antiangiogenic and antiosteoclastic activity. Mandibular osteonecrosis was observed in a 51-year-old female with medullary thyroid cancer receiving cabozantinib, a new tyrosine kinase inhibitor having antiangiogenic activity. The bone necrosis appeared after a dental extraction. The clinical, radiographic and histologic picture of a chronic non-healing extraction socket was consistent with drug-induced osteonecrosis of the jaw. Healing was achieved by segmental ostectomy. The osteonecrosis was likely associated with a vascular endothelial growth factor (VEGF) pathway inhibition, implying inhibition of angiogenesis and hampering of the local host defence mechanisms.
authors.affiliation: Oral Medicine and Oral Oncology Unit, Department of Oncology, University of Turin, Italy.
authors.forename: R
authors.initials: R
authors.lastname: Marino
authors.affiliation: Endocrine Unit, Department of Oncology, University of Turin, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Orlandi
authors.affiliation: Endocrine Unit, Department of Oncology, University of Turin, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Arecco
authors.affiliation: Oral Medicine and Oral Oncology Unit, Department of Oncology, University of Turin, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Gandolfo
authors.affiliation: Oral Medicine and Oral Oncology Unit, Department of Oncology, University of Turin, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Pentenero
mesh_terms: D000813:Anilides / Q000009:adverse effects*; D050071:Bone Density Conservation Agents / Q000009:adverse effects; D005260:Female; D006801:Humans; D008334:Mandible; D008336:Mandibular Diseases / Q000139:chemically induced*; D008875:Middle Aged; D010020:Osteonecrosis / Q000139:chemically induced*; D047428:Protein Kinase Inhibitors / Q000009:adverse effects*; D011725:Pyridines / Q000009:adverse effects*; D013964:Thyroid Neoplasms / Q000188:drug therapy; D014081:Tooth Extraction
chemical_list: D000813:Anilides; D050071:Bone Density Conservation Agents; D047428:Protein Kinase Inhibitors; D011725:Pyridines; C558660:cabozantinib
keywords: Antiangiogenic drugs; VEGF inhibition; cabozantinib; medullary thyroid cancer; osteonecrosis of the jaw