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Incidence of medication-related osteonecrosis of the jaw in patients treated with both bone resorption inhibitors and vascular endothelial growth factor receptor tyrosine kinase inhibitors
journal contribution
posted on 2023-07-26, 14:43 authored by Tom van Cann, Tine Loyson, Annelies Verbiest, Paul M. Clement, Oliver Bechter, Ludo Willems, Isabel Spriet, Ruxandra Coropciuc, Constantinus Politis, Raf O. Vandeweyer, Joseph Schoenaers, Philip R. Debruyne, Herlinde Dumez, Patrick Berteloot, Patrick Neven, Kris Nackaerts, Feng J. S. H. Woei-A-Jin, Kevin Punie, Hans Wildiers, Benoit BeuselinckBackground:
Several case reports and small case series have suggested a higher incidence of medication-related osteonecrosis of the jaw (MRONJ) in patients treated concomitantly with bone resorption inhibitors (BRIs) and vascular endothelial growth factor receptor tyrosine kinase inhibitors (VEGFR-TKIs), as compared to patients treated with BRIs alone. We aimed to assess ONJ-incidence in patients exposed concomitantly to BRIs and VEGFR-TKIs.
Patients and methods:
We reviewed the records of all patients who received VEGFR-TKIs concomitantly with BRIs. Patients, who were treated with BRIs without VEGFR-TKI, served as a control group. Endpoints of the study were total MRONJ-incidence, MRONJ-incidence during the first and second year of exposure, and time-to-ONJ-incidence.
Results:
Ninety patients were treated concomitantly with BRIs and VEGFR-TKIs with a median BRI-exposure of 5.0 months. Total MRONJ-incidence was 11.1%. During the first year of BRI-exposure (with a median concomitant exposure of 4.0 months), 6 out of 90 patients (6.7%) developed a MRONJ, compared to 1.1% in the control group (odds ratio 5.9; 95%CI 2.0–18.0; p = 0.0035). In Kaplan-Meier estimates, time-to-ONJ-incidence was significantly shorter in patients treated with BRIs and VEGFR-TKIs compared to BRIs alone (hazard ratio 9.5; 95%CI 3.1–29.6; p < 0.0001). MRONJs occurred earlier in patients treated concomitantly compared to patients treated with BRIs only (after a median exposure of 4.5 and 25.0 months, respectively; p = 0.0033).
Conclusion:
With a global MRONJ-incidence of 11%, patients receiving concomitant treatment with VEGFR-TKIs and BRIs have a five to ten times higher risk for development of MRONJ compared to patients treated with BRIs alone.
History
Refereed
- Yes
Volume
26Issue number
3Page range
869-878Publication title
Supportive Care in CancerISSN
1433-7339External DOI
Publisher
SpringerLanguage
- other
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Legacy posted date
2019-08-28Legacy Faculty/School/Department
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