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Schreuder WH, Meijer EB, Cleven AHG, Edelenbos E, Klop C, Schreurs R, de Jong RT, van Maarle MC, Horsthuis RBG, de Lange J, van den Berg H. Efficacy and Toxicity of Calcitonin Treatment in Children with Cherubism: A Single-Center Cohort Study. J Bone Miner Res 2023; 38:1822-1833. [PMID: 37823782 DOI: 10.1002/jbmr.4922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 09/19/2023] [Accepted: 10/06/2023] [Indexed: 10/13/2023]
Abstract
Cherubism is a rare autosomal dominant disease characterized by expansile osteolytic jawbone lesions. The effect and safety of off-label calcitonin treatment during the progressive phase of the disease are not well described. In this retrospective study, we present data on the radiological response and adverse effects of subcutaneously administered calcitonin in a cohort of nine cherubism children (three female, six male). Two of the nine patients underwent two separate treatment courses with a significant off-treatment interval in between; therefore, a total of 11 treatment courses with a mean duration of 17.9 months (range <1 to 35, SD 10.8) were studied. To measure the response, the cumulative volume of cherubism lesions was calculated from available three-dimensional imaging. The primary outcome was the change in the volume of lesions during calcitonin treatment and only assessed for the eight treatment courses with a minimal duration of 6 months. A statistically significant reduction in the mean cumulative volume of lesions was seen regardless of treatment duration. Average volume reduction was highest in the first half year of treatment, with a gradual, ongoing reduction thereafter. For the secondary outcome, the change in the cumulative volume of lesions after treatment cessation was assessed for the seven treatment courses with follow-up imaging available. After six of these seven treatment courses, the cumulative volume increased again but remained undoubtedly smaller than the initial volume at the start of therapy. Adverse effects were assessed for all 11 treatment courses and occurred in 73% of them. Most adverse effects were mild and low grade, with the most severe being one grade 3 symptomatic hypocalcemia requiring hospitalization and early treatment termination. Calcitonin treatment seems effective and tolerable in treating actively progressing cherubism in children. However, further research is required to better understand the pharmacological treatment of cherubism, including also other drugs, dosing, and protocols. © 2023 The Authors. Journal of Bone and Mineral Research published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research (ASBMR).
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Affiliation(s)
- Willem H Schreuder
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers Location AMC and Academic Center for Dentistry Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
- Department of Head and Neck Surgery and Oncology, Antoni van Leeuwenhoek, Netherlands Cancer Center, Amsterdam, the Netherlands
| | - Ethan B Meijer
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers Location AMC and Academic Center for Dentistry Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Arjen H G Cleven
- Department of Pathology, University Medical Center Groningen, Groningen, the Netherlands
| | - Esther Edelenbos
- Department of Pediatric Oncology, Amsterdam University Medical Centers Location AMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Cornelis Klop
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers Location AMC and Academic Center for Dentistry Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Ruud Schreurs
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers Location AMC and Academic Center for Dentistry Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Renate T de Jong
- Department of Internal Medicine, Endocrine section, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Merel C van Maarle
- Department of Clinical Genetics, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Roy B G Horsthuis
- Department of Oral and Maxillofacial Surgery, Ziekenhuisgroep Twente, Almelo and Medisch Spectrum Twente, Enschede, the Netherlands
| | - Jan de Lange
- Department of Oral and Maxillofacial Surgery, Amsterdam University Medical Centers Location AMC and Academic Center for Dentistry Amsterdam, University of Amsterdam, Amsterdam, the Netherlands
| | - Henk van den Berg
- Department of Pediatric Oncology, Amsterdam University Medical Centers Location AMC, University of Amsterdam, Amsterdam, the Netherlands
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Liles SI, C Hoppe I, Arnold L. Denosumab Therapy in Cherubism. Cleft Palate Craniofac J 2023; 60:1665-1673. [PMID: 35821585 DOI: 10.1177/10556656221113891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Cherubism is a rare disorder characterized by proliferative fibro-osseous lesions that result in bilateral bony hyperplasia of the face. Management varies based on symptom severity and includes longitudinal follow-up, pharmacotherapy, and/or surgical debulking. Off-label treatment with denosumab, a human monoclonal antibody that binds RANKL and inhibits osteoclast function to reduce bone resorption, can be beneficial in suppressing the proliferation of bone to minimize the need for surgery and to control postoperative reproliferation. Close follow-up is needed to maintain appropriate electrolyte levels. The present case demonstrates the achievement of symptomatic control with denosumab in a child with severe refractory cherubism.
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Affiliation(s)
- Steele I Liles
- School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
| | - Ian C Hoppe
- Division of Plastic Surgery, Department of Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Laura Arnold
- Division of Hematology/Oncology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
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Graillon N, Akintoye SO, Iocca O, Kaleem A, Hajjar S, Imanguli M, Shanti RM. Current concepts in targeted therapies for benign tumors of the jaw - A review of the literature. J Craniomaxillofac Surg 2023; 51:591-596. [PMID: 37852890 DOI: 10.1016/j.jcms.2023.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
The aim of our study was to review current concepts in targeted therapies for benign tumors of the jaw. Benign odontogenic and maxillofacial bone tumors often require radical surgery, with consequent morbidity that impacts patients' postsurgical quality of life. Currently, targeted therapies and novel nonsurgical therapeutics are being explored for management of non-resectable tumors, with the aim of avoiding surgery or minimizing surgical scope. However, data on clinical applications of targeted therapies for benign tumors of the jaw remain sparse. Therefore, a literature review was conducted, based on the PubMed database, which included in vivo human clinical studies describing clinical application of targeted therapy for benign tumor of the jaw. The review assessed the outcomes of BRAF and MEK inhibitors for treatment of ameloblastoma, RANKL monoclonal antibody for treatment of giant cell tumor, cherubism, aneurysmal bone cyst, and fibrous dysplasia, and tyrosine kinase inhibitor for treatment of odontogenic myxoma and cherubism. Targeted therapies decreased tumor size, slowed down tumor progression, and reduced bone pain. Surgery remains the gold standard, but targeted therapies are promising adjuvant or alternative treatment options for reducing tumor progression and morbidity of tumor surgery.
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Affiliation(s)
- Nicolas Graillon
- Aix Marseille Univ, APHM, Univ Gustave Eiffel, LBA, Bd Pierre Dramard, 13916, Marseille, France; Conception University Hospital, Department of Oral and Maxillofacial Surgery, 147 Bd Baille, Marseille, 13005, France.
| | - Sunday O Akintoye
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Oreste Iocca
- Division of Maxillofacial Surgery, Città Della Salute e Della Scienza Hospital, University of Torino, Torino, Italy
| | - Arshad Kaleem
- Head and Neck Oncology and Microvascular Surgery, High Desert Oral and Facial Surgery, El Paso, TX, USA
| | - Souren Hajjar
- Department of Oral and Maxillofacial Surgery, Rutgers School of Dental Medicine, Newark, NJ, USA
| | - Matin Imanguli
- Department of Otolaryngology - Head and Neck Surgery, Robert Wood Johnson Medical School, Associate Member Rutgers Cancer Institute of New Jersey, Newark, NJ, USA
| | - Rabie M Shanti
- Department of Oral and Maxillofacial Surgery, Rutgers School of Dental Medicine, Newark, NJ, USA
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Ladnier E, Sheth A, Shupak RP. Surgical management of mandibular cherubism in an adolescent: integration of virtual surgical planning. BMJ Case Rep 2023; 16:e255059. [PMID: 37669824 PMCID: PMC10481715 DOI: 10.1136/bcr-2023-255059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2023] Open
Abstract
Cherubism, also known as familial fibrodysplasia of the jaw, is an autosomal dominant disorder with variable penetrance. The disease process is characterised by painless and progressive bilateral enlargement of the maxillofacial skeleton. We present an adolescent female with a family history of cherubism who presented to the Oral and Maxillofacial Surgery clinic with progressive bilateral swelling of the mandible. The diagnosis of cherubism was established through a thorough history which was confirmed with an incisional biopsy. The progressive swelling negatively affected her appearance and psychosocial well-being. The patient opted for surgical intervention after a course of conservative management. Although there is often resolution of these lesions into adulthood, surgical intervention may be considered when managing this condition in adolescence. Integration with virtual surgical planning can aid in obtaining desired postoperative outcomes.
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Affiliation(s)
- Emily Ladnier
- Oral and Maxillofacial Surgery, Geisinger Health System, Danville, Pennsylvania, USA
| | - Atmiya Sheth
- Oral and Maxillofacial Surgery, Geisinger Health System, Danville, Pennsylvania, USA
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Cailleaux PE, Porporatti AL, Cohen-Solal M, Kadlub N, Coudert AE. Pharmacological management of cherubism: A systematic review. Front Endocrinol (Lausanne) 2023; 14:1104025. [PMID: 36998472 PMCID: PMC10044089 DOI: 10.3389/fendo.2023.1104025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 02/20/2023] [Indexed: 03/15/2023] Open
Abstract
OBJECTIVE The aim of this systematic review was to determine if there exists an efficacious drug treatment for cherubism, based on published studies. METHODS This systematic review included observational case studies reporting pharmacological management of cherubism. We developed specific search strategies for PubMed (including Medline), ScienceDirect, Web of Science. We evaluated the methodological quality of the included studies using criteria from the Joanna Briggs Institute's critical appraisal tools. RESULTS Among the 621 studies initially identified by our search script, 14 were selected for inclusion, of which five were classified as having a low risk of bias, four as having an unclear risk, and five a high risk. Overall, 18 cherubism patients were treated. The sample size in each case study ranged from one to three subjects. This review identified three types of drugs used for cherubism management: calcitonin, immunomodulators and anti-resorptive agents. However, the high heterogeneity in case reports and the lack of standardized outcomes precluded a definitive conclusion regarding the efficacy of any treatment for cherubism. CONCLUSIONS The present systematic review could not identify an effective treatment for cherubism due to the heterogeneity and limitations of the included studies. However, in response to these shortcomings, we devised a checklist of items that we recommend authors consider in order to standardize the reporting of cherubism cases and specifically when a treatment is given toward identification of an efficacious cherubism therapy. SYSTEMATIC REVIEW REGISTRATION https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022351044, identifier CRD42022351044.
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Affiliation(s)
- Pierre-Emmanuel Cailleaux
- Université Paris Cité, Institut National de la Santé et de la recherche médicale (Inserm) U1132 Biologie de l'os et du cartilage (BIOSCAR), Paris, France
- *Correspondence: Pierre-Emmanuel Cailleaux, ; Amélie E. Coudert,
| | - André Luís Porporatti
- Faculté or Unité de formation et de recherche (UFR) d’Odontologie, Laboratoire de Neurobiologie Oro-Faciale (EA 7543), Université Paris Cité, Paris, France
| | - Martine Cohen-Solal
- Faculté or Unité de formation et de recherche (UFR) de Médecine, Université Paris Cité, Institut National de la Santé et de la recherche médicale (Inserm) U1132 Biologie de l'os et du cartilage (BIOSCAR), Hôpital Lariboisière, Paris, France
| | - Natacha Kadlub
- Faculté or Unité de formation et de recherche (UFR) de Médecine, Université Paris Cité, Inserm 1138, Centre de Recherche des Cordeliers, Paris, France
| | - Amélie E. Coudert
- Faculté or Unité de formation et de recherche (UFR) d’Odontologie, Université Paris Cité, Institut National de la Santé et de la recherche médicale (Inserm) U1132 Biologie de l'os et du cartilage (BIOSCAR), Paris, France
- *Correspondence: Pierre-Emmanuel Cailleaux, ; Amélie E. Coudert,
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Drug Treatment of Low Bone Mass and Other Bone Conditions in Pediatric Patients. Paediatr Drugs 2022; 24:103-119. [PMID: 35013997 DOI: 10.1007/s40272-021-00487-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/01/2021] [Indexed: 10/19/2022]
Abstract
Osteoporosis may affect young individuals, albeit infrequently. In childhood, bone mass increases, reaching its peak between the second and third decades; then, after a period of stability, it gradually declines. Several conditions, including genetic disorders, chronic diseases, and some medications, can have an impact on bone homeostasis. Diagnosis in young patients is based on the criteria defined by the International Society for Clinical Densitometry (ISCD), published in 2013. High risk factors should be identified and monitored. Often simple interventions aimed to eliminate the underlying cause, to minimize the negative bone effects linked to drugs, or to increase calcium and vitamin D intake can protect bone mass. However, in selected cases, pharmacological treatment should be considered. Bisphosphonates remain the main therapeutic agent for children with significant skeletal fragility and are also useful in a large number of other bone conditions. Denosumab, an anti-RANKL antibody, could become a potential alternative treatment. Clinical trials to evaluate the long-term effects and safety of denosumab in children are ongoing.
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