Sunitinib/zoledronic acid
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Bisphosphonates-related osteonecrosis of the jaw in elderly patients: 2 case reports Two elderly men who had metastatic renal cancer developed bisphosphonates-related osteonecrosis of the jaw (BRONJ) during treatment with sunitinib [route not stated] and zoledronic acid. A 65-year-old man, who had lung and lumbosacral metastases, started receiving sunitinib 50 mg/day for 4 weeks every 6 weeks, but the dosage was soon reduced to 37.5 mg/day when he developed mucositis, gingivitis, nausea and diarrhoea. IV zoledronic acid 4mg every 4 weeks was also started and then stopped 1 year later for painful swelling of the right maxilla. The swelling did not progress with macrolide treatment. An exposed bone lesion with oroantral communication was observed, and surgery was performed. He presented 5 months later with exposed bone and maxillary sinusitis, and received ozone therapy and beta-lactam antibacterials. He again underwent surgery in July 2009. His osteonecrosis of jaw lesion progressed, and CT scan showed lesions at the maxillary pterygoid junction and sphenoidal pterygoid processes. Meningitis additionally developed and was efficiently managed pharmacologically. However, he died in the following weeks due to cancer-related complications. A 67-year-old man, who had a progression of cervicodorsal spine metastases, received zoledronic acid [route and dosage not stated] from August 2005 to September 2006; treatment was interrupted when he developed painful swelling of the left mandible, exposed bone and teeth instability. Sunitinib 50 mg/day for 4 weeks every 6 weeks was started in September 2006 and a progression of osteolytic lesions was noted on CT in January 2007. Sunitinib was then administered in conjunction with temsirolimus. Painful swelling of the left mandible and exposed bone were again noted in February 2008. Purulent material was drained, and a cutaneous fistula in the submandibular region was observed. He received antimicrobial rinses and penicillins. CT scan showed a fracture associated with osteolytic lesion and bone sequestration. Hemimandibulolectomy was performed, and a titanium plate was placed in his jaw. However, he died a few months later due to cancer progression. Author comment: "We report the cases of two patients with renal carcinoma under BP [bisphosphonate] medication who developed stage III BRONJ during and after sunitinib administration." Agrillo A, et al. Osteonecrosis of the jaws in patients assuming bisphosphonates and sunitinib: Two case reports. European Review for Medical and 803077183 Pharmacological Sciences 16: 952-957, No. 7, Jul 2012 - Italy
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Reactions 22 Sep 2012 No. 1420
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