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Fusco V, Di Maio M, Valsecchi AA, Santini D, Tucci M, De Giorgi U, Bossi P, Ibrahim T, Cavanna L, Lanzetta G, Rossi M, Rossetti G, Airoldi M, Comandone A, Cinieri S. Treatment of bone metastases from solid tumors with bone-modifying agents: a web survey of Italian oncologists investigating patterns of practice drug prescription and prevention of side effects. Support Care Cancer 2024; 32:202. [PMID: 38427111 PMCID: PMC10907460 DOI: 10.1007/s00520-024-08392-8] [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] [Received: 05/08/2023] [Accepted: 02/16/2024] [Indexed: 03/02/2024]
Abstract
PURPOSE Optimal use of bone-modifying agents (BMAs) in patients with bone metastases from solid tumors is uncertain in some aspects: the drug choice; the planned treatment duration and long-term therapy; the prevention and management of possible side effects, including renal toxicity, hypocalcaemia, and medication-related osteonecrosis of the jaw (MRONJ). METHODS Italian oncologists were invited to fulfil a 24-question web survey about prescription of BMAs for bone metastases of breast cancer, prostate cancer, and other solid tumors. Prevention and management of side effects were also investigated. RESULTS Answers of 191 oncologists were collected. BMAs are usually prescribed at the time of diagnosis of bone metastases by 87.0% (breast cancer) and 76.1% (solid tumors except breast and prostate cancers) of oncologists; the decision is more articulated for prostate cancer (endocrine-sensitive versus castration-resistant). The creatinine level (32.3%), the availability of patient venous access (15.8%), and the type of primary neoplasm (13.6%) are the most reported factors involved in choice between bisphosphonates and denosumab. Zoledronic acid every 3 months was considered as a valid alternative to monthly administration by 94% of Italian oncologists. Oncologists reported a good confidence with measures aimed to prevent MRONJ, whereas uncertainness about prevention and management of hypocalcemia was registered. CONCLUSION Italian oncologists showed a high attitude in prescribing bisphosphonates or denosumab at the time of diagnosis of bone metastases, with a large application of preventive measures of side effects. Further studies are needed to investigate some controversial aspects, such as optimal drug treatment duration and long-term drug schedules.
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Affiliation(s)
- Vittorio Fusco
- Oncology Unit, Department of Medicine, Azienda Ospedaliera-Universitaria "SS Antonio E Biagio e Cesare Arrigo", Alessandria, Italy.
- Translational Medicine Unit, DAIRI Department of Integration, Research and Innovation, Azienda Ospedaliera-Universitaria "SS Antonio E Biagio e Cesare Arrigo", Alessandria, Italy.
| | - Massimo Di Maio
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - Anna Amela Valsecchi
- Department of Oncology, University of Turin, Ordine Mauriziano Hospital, Turin, Italy
| | - Daniele Santini
- UOC Oncologia A, Policlinico Umberto 1, La Sapienza Università, Rome, Italy
| | - Marcello Tucci
- Department of Medical Oncology, Cardinal Massaia Hospital, Asti, Italy
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo Per Lo Studio Dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Paolo Bossi
- Medical Oncology, Humanitas Cancer Center, Milan, Italy
- Italian Network for Supportive Care in Cancer (NICSO), Milan, Italy
| | - Toni Ibrahim
- Osteoncology, Bone and Soft Tissue Sarcomas and Innovative Therapies Unit, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
- Italian Society of Osteoncology (ISO), Bologna, Italy
| | - Luigi Cavanna
- Medicine and Oncology Area, Clinica Piacenza" Hospital, Piacenza, Italy
- Collegio Italiano Dei Primari Oncologi Medici Ospedalieri (CIPOMO), Genoa, Italy
| | - Gaetano Lanzetta
- Medical Oncology Unit, Italian Neuro-Traumatology Institute, Grottaferrata, Italy
- AIOM Guidelines Working Group, Grottaferrata, Italy
| | - Maura Rossi
- Oncology Unit, Department of Medicine, Azienda Ospedaliera-Universitaria "SS Antonio E Biagio e Cesare Arrigo", Alessandria, Italy
| | - Giorgia Rossetti
- Oncology Unit, Department of Medicine, Azienda Ospedaliera-Universitaria "SS Antonio E Biagio e Cesare Arrigo", Alessandria, Italy
| | - Mario Airoldi
- Head Office, Rete Oncologica Di Piemonte E Valle d'Aosta, Turin, Italy
| | | | - Saverio Cinieri
- Medical Oncology Unit, Ospedale Di Summa A. Perrino, Brindisi, Italy
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Halpern LR, Adams DR. Treatment of Medication-Related Osteonecrosis of the Jaw: Controversies in Causality and Therapy. Dent Clin North Am 2024; 68:67-85. [PMID: 37951638 DOI: 10.1016/j.cden.2023.07.005] [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: 11/14/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a most interesting, complex and "elusive" condition seen by the oral health care provider. It is plagued by controversy and although a wealth of research has created clinical treatment databases, there is no "gold standard" algorithm to be applied in a universal fashion. The purpose of this article is to explore several controversies associated with the etiology(s), staging, treatments, and long-term resolution of MRONJ in patients who are treated by the oral health care provider. Controversies for optimizing prevention, and disease control will also be discussed from an interdisciplinary perspective.
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Affiliation(s)
- Leslie Robin Halpern
- New York Medical College/NYCHHC, Metropolitan Hospital, 100 Woods Road, Valhalla, NY 10593, USA.
| | - David Russell Adams
- Section head, Oral and Maxillofacial Surgery, University of Utah, School of Dentistry, 530 South Wakara Way, Salt Lake City, UT 84108, USA
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Roato I, Mauceri R, Notaro V, Genova T, Fusco V, Mussano F. Immune Dysfunction in Medication-Related Osteonecrosis of the Jaw. Int J Mol Sci 2023; 24:ijms24097948. [PMID: 37175652 PMCID: PMC10177780 DOI: 10.3390/ijms24097948] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 04/21/2023] [Accepted: 04/25/2023] [Indexed: 05/15/2023] Open
Abstract
The pathogenesis of medication-related osteonecrosis of the jaw (MRONJ) is multifactorial and there is a substantial consensus on the role of antiresorptive drugs (ARDs), including bisphosphonates (BPs) and denosumab (Dmab), as one of the main determinants. The time exposure, cumulative dose and administration intensity of these drugs are critical parameters to be considered in the treatment of patients, as cancer patients show the highest incidence of MRONJ. BPs and Dmab have distinct mechanisms of action on bone, but they also exert different effects on immune subsets which interact with bone cells, thus contributing to the onset of MRONJ. Here, we summarized the main effects of ARDs on the different immune cell subsets, which consequently affect bone cells, particularly osteoclasts and osteoblasts. Data from animal models and MRONJ patients showed a deep interference of ARDs in modulating immune cells, even though a large part of the literature concerns the effects of BPs and there is a lack of data on Dmab, demonstrating the need to further studies.
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Affiliation(s)
- Ilaria Roato
- CIR-Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Rodolfo Mauceri
- Department of Surgical, Oncological and Oral Sciences, University of Palermo, 90133 Palermo, Italy
| | - Vincenzo Notaro
- CIR-Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
| | - Tullio Genova
- Department of Life Sciences and Systems Biology, University of Torino, 10123 Torino, Italy
| | - Vittorio Fusco
- Medical Oncology Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
- Department of Integrated Research Activity and Innovation (DAIRI), Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, 15121 Alessandria, Italy
| | - Federico Mussano
- CIR-Dental School, Department of Surgical Sciences, University of Turin, 10126 Turin, Italy
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Hussain M, Khan F, Al Hadidi S. The use of bone-modifying agents in multiple myeloma. Blood Rev 2023; 57:100999. [PMID: 36050125 DOI: 10.1016/j.blre.2022.100999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 08/08/2022] [Accepted: 08/09/2022] [Indexed: 01/28/2023]
Abstract
Multiple myeloma is a hematological neoplasm characterized by abnormal proliferation of plasma cells in the bone marrow and is usually associated with increased bone pain and skeletal-related events such as pathological fracture and/or spinal cord compression. Myeloma bone disease results in changes in the bone-marrow microenvironment evidenced by increased osteoclastic activity and/or decreased osteoblastic activity, which negatively affect quality of life. Treatment of myeloma bone disease includes bisphosphonates or denosumab (bone-modifying agents). These agents do not induce the formation of new bone or repair existing bone damage, but they can decrease bone pain and the risk of pathological fracture. While these agents improve quality of life, it is not known whether they improve overall survival. This review focuses on different classes of bone-modifying agents, their mechanisms of action, time of initiation, duration of therapy, and potential survival benefits.
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Affiliation(s)
- Munawwar Hussain
- Myeloma Center, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Fatima Khan
- Department of Hematology Oncology, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America
| | - Samer Al Hadidi
- Myeloma Center, Winthrop P. Rockefeller Cancer Institute, University of Arkansas for Medical Sciences, Little Rock, AR, United States of America.
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Campisi G, Mauceri R, Bedogni A, Fusco V. Re: AAOMS Position Paper on Medication-Related Osteonecrosis of the Jaw—2022 Update. J Oral Maxillofac Surg 2022; 80:1723-1724. [PMID: 36332990 DOI: 10.1016/j.joms.2022.07.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/03/2022] [Accepted: 07/04/2022] [Indexed: 11/06/2022]
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Fusco V, Campisi G, Bedogni A. One changing and challenging scenario: the treatment of cancer patients with bone metastases by bisphosphonates and denosumab, the cost–benefit evaluation of different options, and the risk of medication-related osteonecrosis of the jaw (MRONJ). Support Care Cancer 2022; 30:7047-7051. [PMID: 35312858 PMCID: PMC8935879 DOI: 10.1007/s00520-022-06982-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/11/2022] [Indexed: 12/16/2022]
Affiliation(s)
- Vittorio Fusco
- Oncology Unit, Azienda Ospedaliera Di Alessandria SS, Antonio e Biagio E Cesare Arrigo, Alessandria, Italy.
| | - Giuseppina Campisi
- Department of Surgical, Oncological and Oral Sciences (Di.Chir.On.S.), University of Palermo, Palermo, Italy
| | - Alberto Bedogni
- Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation‑Related Bone Diseases of the Head and Neck, University of Padua, Padua, Italy
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Bennardo F, Buffone C, Fortunato L, Giudice A. Successful Non-surgical Management of a Mandible Fracture Secondary to Medication-related Osteonecrosis of the Jaw: A Unique Case Report. Open Dent J 2020. [DOI: 10.2174/1874210602014010498] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background: Medication-related osteonecrosis of the jaw (MRONJ) may be a severe side effect of bone-modifying agents.
Objective: Pathologic fractures treatment in patients with MRONJ remains challenging. The authors reported a unique case of successful non-surgical management of a mandible fracture secondary to MRONJ.
Methods: A 78-year-old osteoporotic woman with a 4-year history of oral bisphosphonate therapy and a compromised dental condition developed an MRONJ-related right mandibular body fracture. Treatment consisted of systemic antibiotic administration (amoxiclav and metronidazole) and chlorhexidine mouthwash.
Results: Follow-up visits revealed progressive healing of the mandibular fracture with bone callus formation and complete recovery of the ipsilateral lip and chin sensitivity after one year.
Conclusion: Non-surgical management of pathological fractures related to MRONJ might be of interest in patients that refuse any type of surgery, but preventive measures, such as careful dental examination, should be taken before start antiresorptive therapy and during the treatment. The authors reported the first case in the literature of successful management of a mandibular fracture secondary to MRONJ with only antibiotics and mouthwashes.
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Bouland C, Meuleman N, Widelec J, Keiani-Mothlagh K, Voisin C, Lagneaux L, Philippart P. Case reports of medication-related osteonecrosis of the jaw (MRONJ) treated with uncultured stromal vascular fraction and L-PRF. JOURNAL OF STOMATOLOGY, ORAL AND MAXILLOFACIAL SURGERY 2020; 122:212-218. [PMID: 32540361 DOI: 10.1016/j.jormas.2020.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 04/22/2020] [Accepted: 05/25/2020] [Indexed: 01/04/2023]
Abstract
Medication-related osteonecrosis of the jaw (MRONJ) is a challenging affection, considering the absence of a "Gold Standard" treatment. Cell therapy and tissue engineering, using adipose-tissue stromal vascular fraction (SVF) containing mesenchymal stromal cells (MSC) and endothelial progenitor cells (EPC); and a scaffold with healing properties, l-platelet-rich fibrin (L-PRF), could be a therapeutic option. Two cases of MRONJ were treated by tissue engineering. The patients presented respectively a stage-II and a stage-III MRONJ. The protocol consists of SVF injection in the L-PRF applied on the cleaned bone. Patients are followed clinically and by medical imaging (MI) for 18 months. The buccal mucosa was closed within a month. No recurrence was observed during the follow-up. The MI highlighted bone formation. MSC and EPC presence, in the SVF, were confirmed by immunophenotyping. We report the preliminary results of MRONJ patients successfully treated with the association of autologous fresh L-PRF-SVF.
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Affiliation(s)
- C Bouland
- Medicine faculty, université Libre de Bruxelles (ULB), 808, route de Lennik, 1070 Brussels, Belgium; Laboratory of clinical cell therapy (LCCT), campus Erasme, bâtiment de transfusion (Level +1), Jules-Bordet institute, université Libre de Bruxelles (ULB), 808, Route de Lennik, 1070 Brussels, Belgium; Stomatology and maxillofacial surgery department, CHU de Saint-Pierre, 322, rue Haute, 1000 Brussels, Belgium.
| | - N Meuleman
- Laboratory of clinical cell therapy (LCCT), campus Erasme, bâtiment de transfusion (Level +1), Jules-Bordet institute, université Libre de Bruxelles (ULB), 808, Route de Lennik, 1070 Brussels, Belgium; Hematology department, Jules-Bordet institute, université Libre de Bruxelles (ULB), 121, boulevard de Waterloo, 1000 Brussels, Belgium
| | - J Widelec
- Radiology department, hôpitaux IRIS SUD, site Molière, 142, Rue Marconi, 1190 Brussels, Belgium
| | - K Keiani-Mothlagh
- Stomatology and maxillofacial surgery department, hôpitaux IRIS SUD, site Bracops, 79, Rue Docteur-Huet, 1070 Brussels, Belgium
| | - C Voisin
- Stomatology and maxillofacial surgery department, hôpitaux IRIS SUD, site Bracops, 79, Rue Docteur-Huet, 1070 Brussels, Belgium; Private practice maxillofacia clos du parnasse Local 3F, 1050 Brussels, Belgium
| | - L Lagneaux
- Laboratory of clinical cell therapy (LCCT), campus Erasme, bâtiment de transfusion (Level +1), Jules-Bordet institute, université Libre de Bruxelles (ULB), 808, Route de Lennik, 1070 Brussels, Belgium
| | - P Philippart
- Medicine faculty, université Libre de Bruxelles (ULB), 808, route de Lennik, 1070 Brussels, Belgium; Radiology department, hôpitaux IRIS SUD, site Molière, 142, Rue Marconi, 1190 Brussels, Belgium
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Fusco V, Campisi G, Bedogni A. Adjuvant denosumab in early breast-cancer. Lancet Oncol 2020; 21:e124. [PMID: 32135108 DOI: 10.1016/s1470-2045(20)30066-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 01/27/2020] [Indexed: 10/24/2022]
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