Cancer Therapies and ONJ Print Email

Natural History & Resolution of Medication-Related ONJ in Cancer Patients 

March 2018
MASCC members Mark Chambers, Ourania Nicolatou-Galitis, and Deborah Saunders were part of an international research team that conducted an observational case registry study to describe the rate and time course of osteonecrosis of the jaw (ONJ) associated with cancer chemotherapy. ONJ risk factors, treatment patterns, and antiresorptive agents were also tracked in this study, which will appear in Supportive Care in Cancer and is available online (Schiødt M et al., see below*).


ONJ is an adverse drug reaction that leads to progressive destruction of the bone in the maxillofacial region. It is associated with antiresorptive bone-targeted agents used to prevent bone complications in patients with solid tumors that have bone metastasis. The risk of ONJ is also related to time exposure, number of treatments, duration of therapy, and cumulative dosage. ONJ management, ranging from conservative treatment to surgical intervention, is challenging and depends on disease stage. Therapeutic goals include continued cancer therapy while controlling infection, pain, and progression of bone necrosis. While the incidence of ONJ associated with antiresorptive therapy, as well as other risk factors, is well known, information about the management and resolution of ONJ in clinical practice is limited. This case registry study represents a major step toward understanding the course of medication-related ONJ.

In all, 327 patients were enrolled in this study and evaluated by a dental specialist at baseline and every 3 months for 2 years, and then every 6 months for 3 years until death, withdrawal, or loss to follow-up. Most of these patients had received antiresorptive medication before developing ONJ. The results are consistent with those observed in clinical evaluations of skeletal-related events in patients with advanced malignancy involving bone. Nearly 70% of patients with ONJ had resolution or improvement during the study, with half of these having full resolution.

Most previous published findings on medication-related ONJ have been based on small numbers of patients or aggregated data and systematic reviews. The significance of this case registry report is that it documented the effect of specific therapies on ONJ in a substantial number of patients with advanced cancer. It also reports the effects of local oral and medication risk factors for ONJ, as well as treatment, management, and patient outcomes. The authors note that longer follow-up can provide further information about differences in ONJ recurrence and resolution rates between medically and surgically managed patients.
*Schiødt M, Vadhan-Raj S, Chambers MS, Nicolatou-Galitis O, Politis C, Coropciuc, R, Fedele S, Jandial D, Zhang J, Ma H, Saunders DP. A Multicenter Case Registry Study on Medication-Related Osteonecrosis of the Jaw in Patinets with Advanced Cancer. Support Care Cancer. Epub ahead of print (Dec. 23, 2017). Open Access.