Wang Feng, Wei Shengnan, Zhang Zexuan, Zhang Yuan, He Jingya, Sun Bin
Department of Oral and Maxillofacial Surgery, School and Hospital of Stomatology, Jilin University, Changchun, China.
School of Public Health, Jilin University, Changchun, China.
Front Pharmacol. 2022 Aug 10;13:947947. doi: 10.3389/fphar.2022.947947. eCollection 2022.
Medication-related osteonecrosis of the jaw (MRONJ) is an oral complication in cancer patients being treated with either antiresorptives, mainly denosumab and bisphosphonates, or antiangiogenic drugs. Osimertinib is a third-generation epidermal growth factor receptor (EGFR)-tyrosine kinase inhibitor (TKI) for the treatment of patients with EGFR T790M advanced non-small-cell lung cancer (NSCLC). TKI-induced osteonecrosis of the jaw has been reported in recent years, but these cases almost occur in combination with bisphosphonates, and the data on MRONJ associated to osimertinib is scarce. We reported a case of MRONJ associated only with osimertinib. A 69-year-old female patient with NSCLC developed MRONJ after 4 years of treatment with osimertinib. Six months ago, she felt persistent pain and swelling in the right maxilla. After 3 months of pain, her dentist extracted one tooth in the right maxilla under local anesthesia. We examined her gingiva and found fistula and pus spillage. A digital volume tomography scan revealed sequestrum. The patient underwent surgical debridement of the necrotic bone under general anesthesia and administered intravenous antibiotics at the hospital. Histopathological analysis of the bone biopsy revealed a diagnosis of MRONJ. This report provides evidence that osimertinib monotherapy can cause MRNOJ, and has a contribution to explore the formation mechanism of MRONJ. For those patients who take osimertinib, routine oral examinations and monitoring should be performed before and during treatment, as well as prompt closure of wounds and antibiotic treatment to avoid infection after invasive oral surgery such as tooth extraction.
药物相关性颌骨坏死（MRONJ）是接受抗吸收药物（主要是地诺单抗和双膦酸盐）或抗血管生成药物治疗的癌症患者的一种口腔并发症。奥希替尼是一种第三代表皮生长因子受体（EGFR）-酪氨酸激酶抑制剂（TKI），用于治疗EGFR T790M晚期非小细胞肺癌（NSCLC）患者。近年来已有TKI诱导颌骨坏死的报道，但这些病例几乎都与双膦酸盐联合发生，与奥希替尼相关的MRONJ数据很少。我们报告了一例仅与奥希替尼相关的MRONJ病例。一名69岁的NSCLC女性患者在接受奥希替尼治疗4年后发生了MRONJ。6个月前，她感到右上颌持续疼痛和肿胀。疼痛3个月后，她的牙医在局部麻醉下拔除了右上颌的一颗牙齿。我们检查了她的牙龈，发现有瘘管和脓性分泌物。数字容积断层扫描显示有死骨。患者在全身麻醉下接受了坏死骨的手术清创，并在医院接受了静脉抗生素治疗。骨活检的组织病理学分析显示诊断为MRONJ。本报告提供了证据表明奥希替尼单药治疗可导致MRNOJ，并有助于探索MRONJ的形成机制。对于服用奥希替尼的患者，在治疗前和治疗期间应进行常规口腔检查和监测，以及在拔牙等侵入性口腔手术后及时闭合伤口和进行抗生素治疗以避免感染。
