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Osteonecrosis of jaw beyond antiresorptive (bone-targeted) agents: new horizons in oncology
Vittorio Fusco1, Daniele Santini2, Grazia Armento2
1a Medical Oncology , ASO Alessandria , Alessandria , Italy.
Introduction:
Osteonecrosis of the jaw (ONJ) is a clinically important, potentially painful and debilitating condition, which can affect the quality of life of cancer patients. Since 2003, ONJ appeared as a Bisphosphonate(BP)-related class effect, and the term Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) was widespread.
Areas Covered:
Under discussion in this review is the fact that ONJ cases have been reported after treatment including antiangiogenic agents and other "targeted therapy", with and without BPs. Consequently, the comprehensive term Medication-Related Osteonecrosis of the Jaw (MRONJ) has been introduced. The clinical aspects and the prognosis of ONJ associated with these new drugs are still less reported, but basing on their pharmacodynamics, they could be different from the well-known BRONJ. Accordingly, recommendations largely in use for BRONJ should be extended to these new forms, but critically applied and with respect to the individual risk assessment.
Expert Opinion:
There is a high risk of underdiagnoses for ONJ due to a lack of awareness, and too much restrictive or incomplete diagnostic criteria; at the same time, with regard to ONJ associated to the new non -antiresorptive agents, described here, we observe the strong need to improve the defining of any distinguished feature in their diagnosis, prevention and therapy.
Insights
Medication-Related Osteonecrosis of the Jaw (MRONJ) is a growing concern, especially with new targeted therapies. Early diagnosis and individualized risk assessment are crucial for managing this condition in cancer patients.
Area of Science:
- Oncology
- Pharmacology
- Oral Surgery
Background:
- Osteonecrosis of the jaw (ONJ) is a serious condition affecting cancer patients' quality of life.
- Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) emerged as a significant side effect of bisphosphonate therapy.
- The incidence and impact of ONJ have increased with the advent of new cancer treatments.
Purpose of the Study:
- To review the evolving landscape of ONJ, including its association with newer targeted therapies.
- To introduce and define Medication-Related Osteonecrosis of the Jaw (MRONJ).
- To highlight the need for updated diagnostic and therapeutic strategies for MRONJ.
Main Methods:
- Review of current literature on ONJ associated with bisphosphonates and targeted therapies.
- Discussion of the pharmacodynamics of new agents and their potential impact on ONJ.
- Analysis of diagnostic criteria and risk assessment for MRONJ.
Main Results:
- ONJ is increasingly reported with antiangiogenic agents and targeted therapies, with or without bisphosphonates.
- The term Medication-Related Osteonecrosis of the Jaw (MRONJ) encompasses ONJ associated with these newer drug classes.
- Clinical features and prognosis of MRONJ may differ from BRONJ, necessitating critical application of existing recommendations.
Conclusions:
- A high risk of underdiagnosis exists due to lack of awareness and restrictive diagnostic criteria for ONJ.
- There is a critical need to define distinct features for the diagnosis, prevention, and therapy of MRONJ.
- Individualized risk assessment and adapted management strategies are essential for patients at risk of MRONJ.
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