Cancer therapy with an anti-angiogenetic targeted therapy can result in osteonecrosis of the jaw. This has been most often reported in patients with advanced renal cancer.
Anti-angiogenetic targeted therapy may include:
(1) bevacizumab
(2) sunitinib (oral tyrosine kinase inhibitor)
The risk of osteonecrosis is increased if the patient is also taking:
(1) a bisphosphonate
(2) denosumab (monoclonal antibody to the receptor activator of nuclear factor-kappa B ligand)
(3) corticosteroids
Oral mucositis may increase the risk of osteonecrosis.
Recommendations to reduce risk:
(1) Stop smoking.
(2) Maintain good oral hygiene.
(3) Limit alcohol intake.
(4) Avoid combinations of implicated drugs if at all possible.
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