Lenvatinib
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Medication-related osteonecrosis of the jaw: case report A 58-year-old man developed medication-related osteonecrosis of the jaw (MRONJ) during treatment with lenvatinib for metastatic Hurthle cell thyroid cancer. The man, who had Hurthle cell thyroid cancer, developed pulmonary metastasis. Therefore, in February 2017, he started receiving oral lenvatinib 24mg once daily. His concurrent medications consisted of cisplatin, doxorubicin, cyclophosphamide, methotrexate and unspecified chemotherapy. However, he developed severe arthralgia and muscle cramps with ambulation difficulties secondary to lenvatinib therapy. Therefore, lenvatinib dose was decreased to 14mg once daily. After 12 months of lenvatinib therapy, he underwent maxillary left first molar extraction due to concurrent deep caries. However, the socket in the maxilla did not heal. The intraoral examination performed two months after the dental extraction displayed clinical signs of MRONJ. Bone that could be probed through two intraoral fistulas was present, associated with purulent exudation and chronic pain. A panoramic X-ray displayed incomplete bone remodelling in the post-extraction socket. CT scan revealed focal osteosclerosis of the jaw associated with persisting alveolar socket and cortical disruption. Based on the clinical findings, he was diagnosed with MRONJ, which was classified as stage I according to the American Association of Oral and Maxillofacial Surgeons criteria and the Italian consensus. Thereafter, lenvatinib was discontinued. The man was treated with ampicillin, sulbactam, metronidazole, chlorhexidine and sodium hyaluronate. At 6 month follow-up, he was found to be asymptomatic and the intraoral fistulas had healed [time to reaction onsets not stated clearly]. Author comment: "While awaiting new reports to confirm the occurrence of lenvatinib-associated osteonecrosis of the jaw, it is considered that due to it mechanism of action, lenvatinib may be a further anticancer agent associated with this condition." Mauceri R, et al. Medication-related osteonecrosis of the jaw in a cancer patient receiving lenvatinib. International Journal of Oral and Maxillofacial Surgery 48: 1530-1532, No. 12, Dec 2019. Available from: URL: http://doi.org/10.1016/ 803439739 j.ijom.2019.07.010 - Italy
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Reactions 14 Dec 2019 No. 1783
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