Study Reveals Higher Incidence of Jaw Problems Linked to Cancer Treatments

A recent study has uncovered that a serious side effect of certain cancer treatments may be more common than previously thought. The research, published in the Journal of Clinical Oncology, sheds new light on the occurrence of osteonecrosis of the jaw (ONJ) in patients receiving bone-modifying drugs for metastatic breast cancer.

Understanding Osteonecrosis of the Jaw

Osteonecrosis of the jaw is a condition where parts of the jawbone break down and die. It has been associated with bone-modifying drugs used to treat cancer that has spread to the bones. These medications, including denosumab and bisphosphonates like zoledronic acid, are prescribed to alleviate bone-related issues such as pain and fractures in cancer patients.

New Findings Challenge Previous Assumptions

According to a report on the Cancer.gov website, the study conducted in Austria revealed that nearly 9% of individuals with metastatic breast cancer developed ONJ after taking bone-modifying medications. This finding challenges the previous notion that ONJ was a rare side effect of these therapies.

Dr. Christine Brunner, the study’s lead researcher from the Medical University of Innsbruck, emphasized the significance of this discovery, stating:

“This is an important finding since [ONJ] can severely affect the quality of life.”

Denosumab Associated with Higher Risk

The research indicated that patients who received denosumab were almost five times more likely to develop ONJ compared to those who took bisphosphonates. This disparity in risk between the two types of bone-modifying drugs is a crucial consideration for both patients and healthcare providers.

Long-Term Study Provides New Insights

What sets this study apart is its extensive 20-year data collection period. Dr. Stanley Lipkowitz, chief of NCI’s Women’s Malignancies Branch, who was not involved in the study, commented on this aspect:

“By having a longer follow-up, what they found is that with more time on [bone-modifying] therapy, you have a higher rate of [ONJ].”

This longitudinal approach revealed that while the incidence of ONJ was low in the first year of treatment, it continued to increase with each subsequent year of therapy.

Implications for Cancer Treatment

The findings have significant implications for cancer treatment, particularly for patients with metastatic breast cancer. As Dr. Lipkowitz pointed out:

“Other cancers managed similarly [with bone-modifying medicines] could very well have a similar increased rate of [jaw] osteonecrosis.”

This suggests that the increased risk of ONJ may extend to patients with other types of cancer that involve bone metastases, such as multiple myeloma, lung, and prostate cancer.

Preventive Measures and Patient Advice

In light of these findings, experts stress the importance of preventive measures. Dr. Cesar Migliorati from the University of Florida’s College of Dentistry, who was not involved in the study, emphasized the critical role of oral health maintenance and pre-treatment dental examinations.

The Cancer.gov article advises patients taking bone-modifying medicines to:

1. Maintain good oral hygiene
2. Avoid smoking
3. Schedule regular dental check-ups
4. Undergo a dental exam before starting treatment

Balancing Risks and Benefits

The study highlights the need for careful consideration of the risks and benefits associated with bone-modifying drugs. While denosumab has shown superior efficacy in treating bone problems compared to bisphosphonates, the higher risk of ONJ presents a trade-off that healthcare providers must weigh carefully for each patient.

As research continues, ongoing studies are exploring whether less frequent dosing of these medications could potentially reduce the risk of ONJ while maintaining their beneficial effects on bone health in cancer patients.