95IN - Prevention and treatment of osteonecrosis

Date 01 October 2012
Event ESMO Congress 2012
Session Key topics in supportive care
Topics Supportive Measures
Presenter Cesar A. Migliorati
Authors C.A. Migliorati
  • Diagnostic Sciences And Oral Medicine, University of Tennessee Health Science Center College of Dentistry, 38163 - Memphis/US


Jaw osteonecrosis associated with medications (JOM) is a significant oral complication of antiresorptive drugs (intravenous bisphosphonates and denosumab) used in the treatment of cancer patients with metastatic bone disease and multiple myeloma. This complication also develops in individuals with advanced cancers such as metastatic colorectal cancer, advanced nonsquamous non-small cell lung cancer, metastatic kidney cancer, glioblastoma, GIST, and advanced renal cell carcinoma treated with antiangiogenics (bevacizumab and sunitinib). There is also evidence that the use of these medications in combined protocols can increase the risk of JOM. The management of JOM is difficult and patient's quality of life can be compromised. Literature has suggested that the diagnosis and stabilization of dental disease aiming risk minimization prior to starting antiresorptive or antiangiogenic therapy can prevent or reduce the incidence of JOM. Thus, referring patients for dental exam prior to initiating therapy with these drugs is recommended. Conservative dental therapy was the standard of care for JOM. The clinical progress of invasive dental therapy to eliminate necrotic bone was unfavorable with observed aggravation of the clinical defect and with the development of additional necrosis. Recently, more aggressive surgical protocols have been successful when using wide resection of necrotic bone, primary closure of the extraction site and a combination of topical and systemic antibiotics. The objective of this presentation is to update professionals who treat patients with solid tumors with bone metastasis such as breast, prostate and lung cancer, and bone malignancy like multiple myeloma, on the new definition of JOM, clinical characteristics of the lesion, prevention and patient management. Good communication between oncologists and dental professionals is critical for the success of patient management. We expect to demonstrate that this new oral complication could be used as an example to alert health care professionals working in oncology of the importance of maintaining strict surveillance of possible new complications that can develop with the use of new oncologic treatment, a fast developing field.


The author has declared no conflicts of interest.