Bertoldo Francesco, Eller-Vainicher Cristina, Fusco Vittorio, Mauceri Rodolfo, Pepe Jessica, Bedogni Alberto, Palermo Andrea, Romeo Umberto, Guglielmi Giuseppe, Campisi Giuseppina
Department of Medicine, University of Verona, Verona, VR, Italy.
Unit of Endocrinology Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
J Bone Oncol. 2024 Dec 16;50:100656. doi: 10.1016/j.jbo.2024.100656. eCollection 2025 Feb.
Low-doses of bone modifying agents (LD-BMAs) compared to those used to treat bone metastases are used in breast or prostate cancer patients on adjuvant endocrine therapy to prevent Cancer Treatment Induced Bone Loss (CTIBL). Their use is associated with an increased risk of developing Medication-Related Osteonecrosis of the Jaw (MRONJ). However, there is not clarity about strategies aimed to minimize the MRONJ risk in cancer patients at different conditions as low- vs high-doses of BMA. This joint report from the Italian Societies of Oral Pathology and Medicine (SIPMO) and of Italian Society of Osteoporosis, Mineral Metabolism and Skeletal Diseases (SIOMMMS) aims to define the dental management of breast and prostate cancer patients with CTIBL under LD-BMAs, to reduce their risk to develop MRONJ.
This interdisciplinary SIPMO-SIOMMMS Expert Italian Panel reviewed the available international scientific literature and developed a set of recommendations to implement strategies of MRONJ prevention in breast (BC) and prostate cancer (PC) patients undertaking LD-BMAs to prevent CTIBL.
The Expert Panel, after addressing some introductive topics (i.e., CTIBL and its management, pharmacology and pharmacodynamics of BMAs, definition and diagnosis of MRONJ), developed a joint report on the following five issues: a) prevention and dental management in cancer patients candidates to LD-BMAs, or under LD-BMAs; b) prophylactic drug holiday; c) MRONJ treatment; d) LD-BMAs therapeutic drug holiday; and e) restart of LD-BMA treatment after successful healing of MRONJ.Finally, ten key questions with answers were prepared and placed at the end of the document.
Despite obvious weaknesses of the available international literature, the Expert Panel recognized the need to tailor separate MRONJ preventive approach for breast and prostate cancer patients on adjuvant endocrine therapy who begin low-dose BMA therapy to prevent CTIBL and provided this practical guidance for bone specialists and oral healthcare providers. In view of a MRONJ risk for BC and PC patients receiving low-dose BMAs, which approximates that of patients with osteoporosis and other non-malignant diseases undergoing similar treatment schedules, the SIPMO-SIOMMMS Expert Panel recognizes the need for less stringent preventive strategies than those already developed for BC or PC patients with bone metastases taking HD-BMAs.
与用于治疗骨转移的药物相比，低剂量骨改良剂（LD-BMAs）用于接受辅助内分泌治疗的乳腺癌或前列腺癌患者，以预防癌症治疗引起的骨丢失（CTIBL）。其使用与发生药物相关性颌骨坏死（MRONJ）的风险增加有关。然而，对于在不同情况下（如低剂量与高剂量BMA）旨在将癌症患者发生MRONJ的风险降至最低的策略尚不清楚。这份来自意大利口腔病理学和医学学会（SIPMO）以及意大利骨质疏松症、矿物质代谢和骨骼疾病学会（SIOMMMS）的联合报告旨在明确接受LD-BMAs治疗且有CTIBL的乳腺癌和前列腺癌患者的牙科管理，以降低他们发生MRONJ的风险。
这个跨学科的SIPMO-SIOMMMS意大利专家小组回顾了现有的国际科学文献，并制定了一套建议，以在接受LD-BMAs预防CTIBL的乳腺癌（BC）和前列腺癌（PC）患者中实施MRONJ预防策略。
专家小组在讨论了一些介绍性主题（即CTIBL及其管理、BMA的药理学和药效学、MRONJ的定义和诊断）之后，就以下五个问题编写了一份联合报告：a）候选接受LD-BMAs治疗或正在接受LD-BMAs治疗的癌症患者的预防和牙科管理；b）预防性药物假期；c）MRONJ的治疗；d）LD-BMAs治疗性药物假期；以及e）MRONJ成功愈合后重新开始LD-BMA治疗。最后，准备了十个带答案的关键问题并置于文件末尾。
尽管现有国际文献存在明显不足，但专家小组认识到有必要为接受辅助内分泌治疗且开始低剂量BMA治疗以预防CTIBL的乳腺癌和前列腺癌患者量身定制单独的MRONJ预防方法，并为骨专科医生和口腔保健提供者提供了这一实用指南。鉴于接受低剂量BMA的BC和PC患者发生MRONJ的风险与接受类似治疗方案的骨质疏松症和其他非恶性疾病患者相近，SIPMO-SIOMMMS专家小组认识到需要比为接受高剂量BMA的有骨转移的BC或PC患者制定的预防策略更为宽松的预防策略。
