Anti-VEGFR therapy is one of the healing inhibitors of antiresorptive-related osteonecrosis of the jaw
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ORIGINAL ARTICLE
Anti‑VEGFR therapy is one of the healing inhibitors of antiresorptive‑related osteonecrosis of the jaw Chihiro Kanno1 · Tetsuharu Kaneko1 · Manabu Endo1 · Takehiro Kitabatake1 · Tomoko Sakuma1 · Yoshiaki Kanaya1 · Yuki Watanabe1 · Hiroshi Hasegawa1 Received: 2 July 2020 / Accepted: 15 October 2020 © The Japanese Society Bone and Mineral Research 2020
Abstract Introduction Antiresorptive-related osteonecrosis of the jaw (ARONJ) is a rare but serious adverse event associated with bone-modifying agents (BMAs) and affects patients in the terminal stages of cancer. Molecular targeting drugs (MTDs), anti-vascular endothelial growth factor receptor (VEGFR), and anti-epidermal growth factor receptor (EGFR) drugs are essential in various cancer treatments, although MTDs are risk factors for ARONJ. However, the mechanism through which MTDs affect treatment prognosis of ARONJ remains unclear. Therefore, we investigated the potential inhibitory factors for healing in the conservative therapy of ARONJ with a focus on MTDs. Materials and methods Sixty patients who were administered BMAs for the treatment of malignancies and who underwent conservative treatment for ARONJ were assessed. The healing rate of ARONJ for each risk factor was retrospectively evaluated. Results Among the 60 patients, 27 were male and 33 were female. The median age was 67 years, and the median followup period was 292 (range 91–1758) days. The healing rate was lower in those treated with both zoledronic acid (Za) and denosumab (Dmab) than in those treated with Za or Dmab alone (0% vs. 28.8%, p = 0.03). Regarding the administration of MTDs, the treatment rate with anti-VEGFR drugs was 7.1% (p = 0.04), anti-EGFR drugs was 12.5% (p = 0.18), and without MTDs was 36.8%. Conclusion In the conservative treatment of ARONJ, the administration of several BMAs and anti-VEGFR drugs was the factor contributing to the inhibition of healing. Keywords Antiresorptive-related osteonecrosis of the jaw · Vascular endothelial growth factor receptor · Endothelial growth factor receptor · Molecular targeting drug · Conservative therapy
Introduction Metastatic bone tumors are serious complications that exacerbate the quality of life (QOL) of patients with advanced cancer. Bone-modifying agents (BMAs), such as zoledronic acid (Za) and denosumab (Dmab), are essential drugs in anti-cancer therapy to prevent pain and bone fracture and improve hypercalcemia via their potent antiresorptive effects [1, 2]. However, a serious adverse event associated with these drugs, known as antiresorptive-related osteonecrosis * Hiroshi Hasegawa [email protected] 1
Department of Oral and Maxillofacial Surgery, Fukushima Medical University Hospital, 1 Hikarigaoka, Fukushima City, Fukushima, 960‑1295, Japan
of the jaw (ARONJ), can impair a patient’s QOL in the stage of terminal cancer. ARONJ was first reported 13 years ago [3], and many studies have reported on the onset mechanism, prevention, and treatment methods. Nevertheless, we continue to remain tasked with the managem
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