Fusco Vittorio, Santini Daniele, Armento Grazia, Tonini Giuseppe, Campisi Giuseppina
a Medical Oncology , ASO Alessandria , Alessandria , Italy.
b Medical Oncology , Università Campus Bio-Medico of Rome , Rome , Italy.
Expert Opin Drug Saf. 2016 Jul;15(7):925-35. doi: 10.1080/14740338.2016.1177021. Epub 2016 May 3.
Osteonecrosis of the jaw (ONJ) is a clinically important, potentially painful and debilitating condition, which can affect the quality of life of cancer patients. Since 2003, ONJ appeared as a Bisphosphonate(BP)-related class effect, and the term Bisphosphonate-Related Osteonecrosis of the Jaw (BRONJ) was widespread.
Under discussion in this review is the fact that ONJ cases have been reported after treatment including antiangiogenic agents and other "targeted therapy", with and without BPs. Consequently, the comprehensive term Medication-Related Osteonecrosis of the Jaw (MRONJ) has been introduced. The clinical aspects and the prognosis of ONJ associated with these new drugs are still less reported, but basing on their pharmacodynamics, they could be different from the well-known BRONJ. Accordingly, recommendations largely in use for BRONJ should be extended to these new forms, but critically applied and with respect to the individual risk assessment.
There is a high risk of underdiagnoses for ONJ due to a lack of awareness, and too much restrictive or incomplete diagnostic criteria; at the same time, with regard to ONJ associated to the new non -antiresorptive agents, described here, we observe the strong need to improve the defining of any distinguished feature in their diagnosis, prevention and therapy.
颌骨骨坏死（ONJ）是一种具有临床重要性、可能引发疼痛且使人衰弱的病症，会影响癌症患者的生活质量。自2003年以来，ONJ作为双膦酸盐（BP）相关的类效应出现，“双膦酸盐相关颌骨骨坏死（BRONJ）”这一术语广泛传播。
本综述所讨论的是，在包括抗血管生成药物和其他“靶向治疗”的治疗后，无论是否使用双膦酸盐，均有ONJ病例报告。因此，引入了“药物相关颌骨骨坏死（MRONJ）”这一综合术语。与这些新药相关的ONJ的临床情况和预后报道仍较少，但基于其药效学，它们可能与广为人知的BRONJ有所不同。相应地，目前广泛用于BRONJ的建议应扩展至这些新形式，但需谨慎应用并考虑个体风险评估。
由于认识不足以及诊断标准过于严格或不完整，ONJ存在漏诊的高风险；同时，对于本文所述的与新型非抗吸收药物相关的ONJ，我们强烈认为有必要改进其诊断、预防和治疗中任何显著特征的界定。
