Troeltzsch Matthias, Woodlock Timothy, Kriegelstein Stefanie, Steiner Timm, Messlinger Karl, Troeltzsch Markus
Ansbach General Hospital, Germany.
J Can Dent Assoc. 2012;78:c85.
Patients undergoing cancer chemotherapy are living longer and with better quality of life, and they require dental care both during and after their treatments. Bisphosphonates have been associated with drug-related osteonecrosis of the jaw (ONJ) since the discoveries of Marx in 2003 and Ruggiero and Woo in 2008. Recent literature has indicated a similar association with nonbisphosphonate drugs used in cancer therapy. Denosumab, an osteoclast inhibitor with applications in orthopedics and oncology, causes ONJ at a rate comparable to that for intravenously administered bisphosphonates. Case reports and drug agency records have indicated a correlation between ONJ and the neoangiogenesis inhibitors bevacizumab and sunitinib, which are used to treat many common cancers. The pharmacologic mechanisms of these 3 drugs appear distinct, yet a common effect on bone metabolism may occur in susceptible hosts. This review explores the mechanisms of these drugs that could lead to ONJ, according to current scientific understanding. The American Academy of Oral and Maxillofacial Surgeons has provided detailed recommendations for the management of bisphosphonate-related ONJ, which we suggest should also be applied in the management of patients with exposure to denosumab, bevacizumab and sunitinib.
接受癌症化疗的患者寿命延长，生活质量提高，他们在治疗期间及之后都需要牙科护理。自2003年马克思以及2008年鲁杰罗和吴的发现以来，双膦酸盐已与药物相关的颌骨坏死（ONJ）有关。最近的文献表明，癌症治疗中使用的非双膦酸盐药物也有类似关联。地诺单抗是一种在骨科和肿瘤学中应用的破骨细胞抑制剂，其导致ONJ的发生率与静脉注射双膦酸盐相当。病例报告和药品机构记录表明，ONJ与用于治疗多种常见癌症的新血管生成抑制剂贝伐单抗和舒尼替尼之间存在关联。这三种药物的药理机制似乎不同，但在易感宿主中可能对骨代谢产生共同影响。根据目前的科学认识，本综述探讨了这些药物可能导致ONJ的机制。美国口腔颌面外科医师学会已为双膦酸盐相关ONJ的管理提供了详细建议，我们建议这些建议也应适用于接触地诺单抗、贝伐单抗和舒尼替尼的患者的管理。
