Jaw osteonecrosis associated with aflibercept, irinotecan and fluorouracil: attention to oral district.
BACKGROUND
The antiangiogenic monoclonal antibody aflibercept in association with fluorouracil and irinotecan improves the survival of patients with metastatic colorectal cancer (mCRC) treated previously with oxaliplatin-based therapy. Multiple reports raised the hypothesis that the concomitant use of antiresorptive drugs and antiangiogenic drugs may increase the risk of osteonecrosis of the jaw (ONJ). Some reports have been published regarding cases of ONJ during treatment with bevacizumab for mCRC.


METHODS
Here we describe the first reported case of ONJ occurring in a 64-year-old woman with untreated periodontitis and episodic previous pyorrhea occurring during treatment with aflibercept plus FOLFIRI during the expanded-access program.


CONCLUSIONS
This case report warrants further investigation into the potential association between the use of anti-VEGF agents and ONJ. Given the serious nature of ONJ, we recommend that particular attention be paid to the oral district prior to treating patients and during treatment with chemotherapy and targeted agents, especially anti-VEGF agents. Such measures could also be useful in reducing the incidence of stomatitis.
Colorectal Cancer Unit, Division of Medical Oncology 1, San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin - Italy.
Agostino
A
Ponzetti
Colorectal Cancer Unit, Division of Medical Oncology 1, San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin - Italy.
Francesco
F
Pinta
Colorectal Cancer Unit, Division of Medical Oncology 1, San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin - Italy.
Rosella
R
Spadi
Colorectal Cancer Unit, Division of Medical Oncology 1, San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin - Italy.
Caterina
C
Mecca
Colorectal Cancer Unit, Division of Medical Oncology 1, San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin - Italy.
Laura
L
Fanchini
Colorectal Cancer Unit, Division of Medical Oncology 1, San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin - Italy.
Marcello
M
Zanini
Colorectal Cancer Unit, Division of Medical Oncology 1, San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin - Italy.
Libero
L
Ciuffreda
Colorectal Cancer Unit, Division of Medical Oncology 1, San Giovanni Battista Hospital, Città della Salute e della Scienza, Turin - Italy.
Patrizia
P
Racca
D020533:Angiogenesis Inhibitors / Q000009:adverse effects; D000911:Antibodies, Monoclonal / Q000009:adverse effects; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects* / Q000627:therapeutic use; D002166:Camptothecin / Q000008:administration & dosage / Q000031:analogs & derivatives; D015179:Colorectal Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D017809:Fatal Outcome; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D006801:Humans; D000077146:Irinotecan; D007571:Jaw Diseases / Q000175:diagnosis / Q000209:etiology*; D008875:Middle Aged; D010020:Osteonecrosis / Q000175:diagnosis / Q000209:etiology*; D040262:Receptors, Vascular Endothelial Growth Factor / Q000008:administration & dosage; D011993:Recombinant Fusion Proteins / Q000008:administration & dosage; D014057:Tomography, X-Ray Computed
D020533:Angiogenesis Inhibitors; D000911:Antibodies, Monoclonal; D011993:Recombinant Fusion Proteins; C533178:aflibercept; D000077146:Irinotecan; D040262:Receptors, Vascular Endothelial Growth Factor; D005472:Fluorouracil; D002166:Camptothecin