MEDICATION-RELATED OSTEONECROSIS OF THE JAW ASSOCIATED WITH PAZOPANIB AND ORAL BISPHOSPHONATES

Abstract

The drugs most commonly associated with medication-related osteonecrosis of the jaw (MRONJ) are bisphosphonates (BPs), denosumab, as well as bevacizumab and sunitinib, among others. MRONJ prevalence among oral BP (OBP) users varies from 0.004% to 0.1%, reaching 0.21% after 4 years of use. Pazopanib is a multi-tyrosine kinase inhibitor used for the treatment of renal cell carcinoma (RCC). To date, about 12 cases of MRONJ associated with pazopanib have been reported. A 64-year-old woman was referred presenting bone exposure in the mandible 60 days ago. There was no history of local surgery or trauma. Her medications included pazopanib for RCC treatment 7 months ago and OBPs for osteoporosis treatment 8 years ago. Clinical, radiographic, and histopathologic findings were consistent with MRONJ. The potential risk due to the simultaneous use of 2 drugs known to be associated with MRONJ should be better clarified with the report of further cases.