Osteonecrosis of the jaws in patients assuming bisphosphonates and sunitinib: two case reports

Osteonecrosis of the jaw (ONJ) is an unremitting adverse outcome associated with bisphosphonate therapy, primarily intravenously administered, in patients with bone metastases from solid tumors, multiple myeloma and osteometabolic diseases. From 2003 many cases of bisphosphonates related osteonecrosis of the jaw (BRONJ) have been reported in literature. Sunititnib is a novel anticancer agent used in gastrointestinal cancers and renal cancers resistant to imatinib. Recent reports describe the onset of ONJ in patients treated with both sunitinib and bisphosponates. A case of osteonecrosis of the jaw related to sunitinib, without association of bisphosphonate (BP) medications has been recently reported. A recent hypothesis suggests that antiangiogenic drugs such as sunitinib could cause ONJ even without the association with BPs. We describe a case of two patients affected by renal carcinoma under BP and sunitinib medication who developed stage III bisphosphonates-related osteonecrosis of the jaw (BRONJ).