title: Osteonecrosis of jaw beyond antiresorptive (bone-targeted) agents: new horizons in oncology.
abstract: BACKGROUND
  Osteonecrosis of the jaw (ONJ) is a clinically important, potentially painful and debilitating condition, which can affect the quality of life of cancer patients. Since 2003, ONJ appeared as a Bisphosphonate(BP)-related class effect, and the term Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) was widespread.
  
  
  METHODS
  Under discussion in this review is the fact that ONJ cases have been reported after treatment including antiangiogenic agents and other "targeted therapy", with and without BPs. Consequently, the comprehensive term Medication-Related Osteonecrosis of the Jaw (MRONJ) has been introduced. The clinical aspects and the prognosis of ONJ associated with these new drugs are still less reported, but basing on their pharmacodynamics, they could be different from the well-known BRONJ. Accordingly, recommendations largely in use for BRONJ should be extended to these new forms, but critically applied and with respect to the individual risk assessment.
  
  
  CONCLUSIONS
  There is a high risk of underdiagnoses for ONJ due to a lack of awareness, and too much restrictive or incomplete diagnostic criteria; at the same time, with regard to ONJ associated to the new non -antiresorptive agents, described here, we observe the strong need to improve the defining of any distinguished feature in their diagnosis, prevention and therapy.
authors.affiliation: a Medical Oncology , ASO Alessandria , Alessandria , Italy.
authors.forename: Vittorio
authors.initials: V
authors.lastname: Fusco
authors.affiliation: b Medical Oncology , Università Campus Bio-Medico of Rome , Rome , Italy.
authors.forename: Daniele
authors.initials: D
authors.lastname: Santini
authors.affiliation: b Medical Oncology , Università Campus Bio-Medico of Rome , Rome , Italy.
authors.forename: Grazia
authors.initials: G
authors.lastname: Armento
authors.affiliation: b Medical Oncology , Università Campus Bio-Medico of Rome , Rome , Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Tonini
authors.affiliation: c Department of Surgical, Oncology and Dental disciplines , Università degli Studi di Palermo , Palermo , Italy.
authors.forename: Giuseppina
authors.initials: G
authors.lastname: Campisi
mesh_terms: D020533:Angiogenesis Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects; D059266:Bisphosphonate-Associated Osteonecrosis of the Jaw / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D006801:Humans; D007571:Jaw Diseases / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D058990:Molecular Targeted Therapy; D009369:Neoplasms / Q000188:drug therapy*; D010020:Osteonecrosis / Q000139:chemically induced* / Q000175:diagnosis / Q000473:pathology; D011788:Quality of Life; D018570:Risk Assessment / Q000379:methods
chemical_list: D020533:Angiogenesis Inhibitors; D000970:Antineoplastic Agents
keywords: Bisphosphonate; Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ); Medication-Related Osteonecrosis of the Jaw (MRONJ); Osteonecrosis of the jaw (ONJ); aflibercept; bevacizumab; denosumab; everolimus; sunitinib; temsirolimus