Osteonecrosis of the Jaws in Patients Taking Sunitinib Unexposed to Bisphosphonates: Two Case Reports

(Pages: 43-50)

Alessio Gambino, Marco Cabras, Alessandro Dell’Acqua, Stefano Carossa, Monica Brega and Francesco Erovigni

Department of Surgical Sciences, CIR-Dental School, University of Turin, Turin, Italy

DOI: https://doi.org/10.30576/2414-2050.2020.06.8

 

 

Abstract: Background: Sunitinib-related Osteonecrosis of the Jaw (ONJ) has emerged in oncologic patients, even if unexposed to bisphosphonates (BPs). Aim of the study was to describe two cases of sunitinib-related ONJ among patients unexposed to BPs.
Methods: Case 1: 57 years-old male, smoker, under sunitinib for IV-grade renal carcinoma complained of recurrent pain and swelling of two lower right premolars. Ortopanthomography (OPT) showed periapical demineralization, confirmed by Computerized tomography (CT) scan. Two grams daily of amoxicillin/clavulanate for 6 days, and premolars’ extractionwere performed during drug-holiday. Poor healing and infection of extraction site lead to diagnosis of stage 2B ONJ.
Case 2: 77 years-old female, not smoker, under sunitinib for advanced gastric cancer was referred for asymptomatic bone exposurenear the left posterior mylohyoid line. CT scan showed bone disruption within the lingual cortical of left mandible, with no odontogenous etiology, leading to diagnosis of stage 2A ONJ.
Results: Both cases were successfully treated as follows: after full thickness flapwith no release incisions, bone debridement was carried out with piezosurgery until evidence of bleeding bone, followed by suture with primary intention closure. Perioperative antibiotic regimen (3 grams of Amoxicillin/clavulanateplus 1.5 grams of metronidazoledaily from 2 days before to 7 days after surgery), and topical antisepsis (cholrhexidine 0.12% mouthwash 3 times daily from 1 week before to 1 week after surgery) were provided.
Conclusion: Sunitinib alone can be associated with MRONJ. With anecdotal evidence available so far, further studies are need to clarify the nature of this association.

Keywords: Sunitinib, osteonecrosis, bisphosphonates, surgery.