Abstract
Objectives To review the available literature on medication-related osteonecrosis of the jaw (MRONJ) associated with antiangiogenics in antiresorptive-naïve individuals. Methods A literature search was performed using MEDLINE via PubMed, EMBASE, and Web of Science in December 2017. Results We identified reports describing a total of 35 antiresorptive drugs-naïve patients who developed antiangiogenic-related MRONJ. The mean age of these patients was 59.06 years and the F : M ratio was 4 : 5. The most common underlying disease was metastatic renal cell cancer. Pain to the mandible was the most common complaint (34.29%) and the majority of patients presented with bone exposure. The mean duration of intravenous and oral antiangiogenics before MRONJ development was 6.5 and 16.72 months, respectively. The most common additional risk factor was dental extraction (37.14%). Almost half of the MRONJ patients (48.57%) received surgical treatment. 18 patients (62.06%) were reported to have disease resolution within an average time of 6.75 months. Conclusion MRONJ associated with antiangiogenic therapy in antiresorptive-naïve patients is a rare but potentially serious adverse effect. Available data suggests that there might be notable differences between MRONJ associated with antiangiogenics and antiresorptives; however, further prospective well-designed studies are required.
Highlights
Medication-related osteonecrosis of the jaw (MRONJ) is an uncommon and potentially serious adverse side effect of antiresorptive and antiangiogenic agents [1]
Inclusion criteria were patients developing MRONJ associated with antiangiogenic agents based on the definition of MRONJ proposed by the special committee on MRONJ of the American Association of Oral and Maxillofacial Surgeons (AAOMS) in 2014 [1]
A total of 4,597 articles were retrieved by the initial search, including literature reviews, duplicate articles, clinical trials, and case reports with bisphosphonates and antiangiogenic treatment
Summary
Medication-related osteonecrosis of the jaw (MRONJ) is an uncommon and potentially serious adverse side effect of antiresorptive and antiangiogenic agents [1]. It can cause chronic pain, infection, dysfunction, and disfigurement and can affect the quality of life of affected individuals [2, 3]. A notably smaller number of cases are associated with the use of antiangiogenic agents, both in individuals who take antiresorptive drugs and in those who are antiresorptive drugs-naıve [8]. The use of antiangiogenic agents in combination with antiresorptive drugs is known to increase the risk of MRONJ development [13]; little is known regarding the incidence and prevalence of antiangiogenic-related MRONJ in antiresorptive drugs-naıve individuals. The mammalian target of rapamycin (mTOR) inhibitors seems to have antiangiogenic effects by inhibiting the production of VEGF and platelet-derived growth factors (PDGF) [16,17,18]
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