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Letters to the Editor

Osteonecrosis of the Jaw and the Use of Antiangiogenic Agents: Just an Association?

^aGeorge Washington University Medical Center, Washington, DC, USA; ^bMedical Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland, USA

Correspondence: Jeanny B. Aragon-Ching, M.D., George Washington University Medical Center, Medical Faculty Associates, Division of Hematology/Oncology, 2150 Pennsylvania Avenue, Suite 3-428, Washington, DC 20037, USA. Telephone: 202-741-2478; Fax: 202-741-2487; e-mail: jaragonching{at}mfa.gwu.edu

Received September 15, 2008; accepted for publication October 31, 2008; first published online in THE ONCOLOGIST Express on December 16, 2008.

Disclosure: The article discusses the use of bevacizumab (Genentech) for prostate cancer and thalidomide (Celgene) for prostate cancer.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias. No financial relationships relevant to the content of this article have been disclosed by the authors, planners, independent peer reviewers, or staff managers.

We read with interest the article by Estilo et al. [1] that appeared in The Oncologist 2008;13:911–920 regarding osteonecrosis of the jaw (ONJ) in patients with advanced cancer treated with bisphosphonate therapy. One of the hypotheses regarding development of ONJ is inhibition of capillary angiogenesis [2]. The authors commented that their analysis showed a negative association between the use of antiangiogenic agents and development of ONJ. Reference was made to our study that showed an increased incidence of ONJ using docetaxel, prednisone, thalidomide, and bevacizumab in patients with metastatic castration-resistant prostate cancer [3]. An updated analysis of this trial showed that the incidence of ONJ was 18.3% (95% confidence interval, 9%–28%), in 11 of 60 patients enrolled [4]. Although the drug regimen used in this trial is experimental, and variable contributions from the use of i.v. bisphosphonates and antiangiogenic agents are indistinguishable, we hypothesized that the addition of agents that target angiogenesis could potentiate an additive effect to the known antiangiogenic properties of zoledronic acid [5]. In fact, the same authors recently reported two patients who developed ONJ after receiving bevacizumab, without a history of antecedent bisphosphonate use [6]. Thus, these findings are of clinical relevance, especially in the era of targeted antiangiogenic therapy, when these agents, either bisphosphonates or antiangiogenic drugs, are clinically moving forward from the metastatic to the adjuvant setting.

	REFERENCES

Top References

 

1. Estilo CL, Van Poznak CH, Wiliams T et al. Osteonecrosis of the maxilla and mandible in patients with advanced cancer treated with bisphosphonate therapy. The Oncologist 2008;13:911–920.[Abstract/Free Full Text]
2. Marx RE, Sawatari Y, Fortin M et al. Bisphosphonate-induced exposed bone (osteonecrosis/osteopetrosis) of the jaws: Risk factors, recognition, prevention, and treatment. J Oral Maxillofac Surg 2005;63:1567–1575.[CrossRef][Medline]
3. Aragon-Ching JB, Ning YM, Latham L et al. Osteonecrosis of the jaw (ONJ) in androgen-independent prostate cancer (AIPC) patients receiving ATTP (bevacizumab, docetaxel, thalidomide, and prednisone). J Clin Oncol 2007;25:19594.
4. Aragon-Ching JB, Ning YM, Chen C et al. Higher incidence of osteonecrosis of the jaw (ONJ) in patients with metastatic castration resistant prostate cancer treated with anti-angiogenic agents. Cancer Invest 2008 (in press).
5. Wood J, Bonjean K, Ruetz S et al. Novel antiangiogenic effects of the bisphosphonate compound zoledronic acid. J Pharmacol Exp Ther 2002;302:1055–1061.[Abstract/Free Full Text]
6. Estilo CL, Fornier M, Farooki A et al. Osteonecrosis of the jaw related to bevacizumab. J Clin Oncol 2008;26:4037–4038.[Free Full Text]

This Article Full Text (PDF) All Versions of this Article: theoncologist.2008-0206v1 13/12/1314    most recent eLetters: Submit a response to this article Purchase Article View Shopping Cart Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services E-mail this article link to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Reprints/Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Aragon-Ching, J. B. Articles by Dahut, W. L. Search for Related Content PubMed PubMed Citation Articles by Aragon-Ching, J. B. Articles by Dahut, W. L.