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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