title: Osteonecrosis of the jaw during sorafenib therapy for hepatocellular carcinoma.
abstract: BACKGROUND
  Sorafenib is an oral multiple tyrosine kinase inhibitor and is currently the only evidence-based treatment recommended for advanced hepatocellular carcinoma. We report a case of osteonecrosis of the jaw that occurred during sorafenib therapy in a patient with advanced hepatocellular carcinoma not treated with bisphosphonates or other antiangiogenic drugs.
  
  
  METHODS
  A systematic search in PubMed yielded some cases of osteonecrosis of the jaw in patients treated with antiangiogenic agents, alone or in combination with bisphosphonates, for metastatic renal cell carcinoma. The only case of osteonecrosis observed during sorafenib therapy not combined with other predisposing agents was described by Guillet et al.
  
  
  RESULTS
  A 74-year-old man diagnosed with hepatocellular carcinoma ensuing in hepatitis C virus infection, who was treated with sorafenib at a daily dose of 400 mg, developed osteonecrosis of the right mandibular body. The lesion was documented by a dental CT scan and surgical evaluation did not lead to an indication for curettage treatment. Sorafenib was discontinued because of the radiological and laboratory features of hepatocellular carcinoma progression and the high risk of jaw fracture.
  
  
  CONCLUSIONS
  To our knowledge, this is the first description of osteonecrosis of the jaw detected in a cirrhotic patient on sorafenib therapy not combined with bisphosphonates.
authors.affiliation: Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna - Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Garuti
authors.affiliation: Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna - Italy.
authors.forename: Vittoria
authors.initials: V
authors.lastname: Camelli
authors.affiliation: Department of Head and Neck and Sense Organs, Neuroradiology Unit, S. Orsola-Malpighi Hospital, University of Bologna, Bologna - Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Spinardi
authors.affiliation: Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna - Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Bucci
authors.affiliation: Department of Medical and Surgical Sciences, Alma Mater Studiorum-University of Bologna, Bologna - Italy.
authors.forename: Franco
authors.initials: F
authors.lastname: Trevisani
mesh_terms: D000368:Aged; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000009:adverse effects*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D003131:Combined Modality Therapy; D018450:Disease Progression; D017809:Fatal Outcome; D006801:Humans; D007568:Jaw / Q000473:pathology*; D008113:Liver Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D009536:Niacinamide / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D010020:Osteonecrosis / Q000175:diagnosis* / Q000209:etiology*; D010671:Phenylurea Compounds / Q000008:administration & dosage / Q000009:adverse effects*; D047428:Protein Kinase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D000077157:Sorafenib; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents; D010671:Phenylurea Compounds; D047428:Protein Kinase Inhibitors; D009536:Niacinamide; D000077157:Sorafenib