Department of Oral & Maxillofacial Surgery, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
J Craniomaxillofac Surg. 2013 Jun;41(4):e65-9. doi: 10.1016/j.jcms.2012.10.014. Epub 2012 Dec 21.
In the treatment of osteoporosis, M. Kahler and bone metastases from prostate and breast cancer bisphosphonates play a major role. Not all patients respond well to bisphosphonate treatment. Since a few years adverse effects of these drugs have been reported. A new drug, denosumab, a fully human monoclonal antibody to RANKL, has recently been developed. This case reports a 74-year-old male patient with a medical history of diabetes mellitus, angina pectoris, coronary bypasses, hypertension, and prostate cancer with multiple metastases to lymph nodes, bone and lungs. The prostate cancer was treated according to the protocol. But he was never treated with bisphosphonates. Instead he was included in a phase III randomized double blind multicenter trial, testing the efficacy of denosumab compared to zoledronic acid in the treatment of bone metastases of hormone resistant prostate cancer. Only 7 months after start of denosumab infectious symptoms developed, followed by infestation of the mandible. Despite surgical treatment fistula and exposed bone remained. This case illustrates that use of denosumab can lead to a type of osteonecrosis resembling bisphosphonate related osteonecrosis of the jaws.
在骨质疏松症的治疗中，M. Kahler 和前列腺癌和乳腺癌的骨转移双膦酸盐发挥了重要作用。并非所有患者对双膦酸盐治疗都有良好反应。由于这些药物的一些不良反应已经被报道。一种新的药物，地舒单抗，一种针对 RANKL 的全人源单克隆抗体，最近已经被开发出来。本病例报告了一名 74 岁男性患者，有糖尿病、心绞痛、冠状动脉旁路、高血压和前列腺癌病史，伴有多个淋巴结、骨和肺转移。前列腺癌根据方案进行了治疗。但他从未接受过双膦酸盐治疗。相反，他被纳入了一项针对激素难治性前列腺癌骨转移的地舒单抗与唑来膦酸疗效的 III 期随机双盲多中心试验。仅仅在开始用地舒单抗 7 个月后，就出现了感染症状，随后下颌骨受到感染。尽管进行了手术治疗，但仍存在瘘管和暴露的骨头。本病例说明，使用地舒单抗可能会导致一种类似于双膦酸盐相关性下颌骨坏死的骨坏死。
