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Bisphosphonate osteonecrosis of the jaws in cancer patients
The Breast 18 (2009) 335
Contents lists available at ScienceDirect
The Breast journal homepage: www.elsevier.com/brst
Letter to the Editor
Bisphosphonate osteonecrosis of the jaws in cancer patients
Sir, We read with interest the review article by Fehm et al1 reporting the recommendations of the multidisciplinary task force on behalf of the German society of senology. The authors report that in comparison to patients with bone metastases, breast-cancer patients receiving adjuvant bisphosphonates with a less frequent dosing schedule are at a substantially lower risk of developing osteonecrosis of the jaws (ONJ). This information derives from a number of manufacturer-sponsored clinical trials summarized in Table 1 of their manuscript.1 This is accurate; however one should consider that the incidence of osteonecrosis of the jaws was also reported to be negligible in manufacturer-sponsored clinical trials of bisphosphonates performed in patients with bone metastasis.2 Fehm et al. report that there is currently no profound evidence that any specific malignant disease would present an increased risk for ONJ.1 In this regard, a longitudinal cohort study of multiple myeloma, breast and prostate cancer patients, where ONJ was the primary end-point, has recently been published. The latter study demonstrated that type of malignant disease is not associated with increased ONJ incidence, through a multivariate model which controlled for sex, age, smoking status, history of dental work and type of bisphosphonate administered.3
0960-9776/$ – see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.breast.2009.09.003
References 1. Fehm T, Felsenberg D, Krimmel M, Solomayer E, Wallwiener D, Hadjii P. Bisphosphonate-associated osteonecrosis of the jaw in breast cancer patients: recommendations for prevention and treatment. Breast; 2009;18(4):213–7. 2. Kyrgidis A. Bisphosphonate-related osteonecrosis of the jaw in randomized clinical trials. Breast Cancer Res Treat; 2009; doi:10.1007/s10549-009-0466-2. 3. Vahtsevanos K, Kyrgidis A, Verrou E, et al. Bisphosphonate related osteonecrosis of the jaws: a longitudinal cohort study of risk factors in cancer patients. J Clin Oncol; 2009; doi:10.1200/JCO.2009.21.9584.
Athanassios Kyrgidis* Department of Oral and Maxillofacial Surgery, Theagenio Cancer Hospital, 3 Papazoli St., 54630 Thessaloniki, Greece Corresponding author. Tel.: þ30 6947566727; fax: þ30 2310546701. E-mail address: [email protected] Charalambos Andreadis 3rd Department of Clinical Oncology, Theagenio Cancer Hospital, 2 A. Simeonidi St., 54639 Thessaloniki, Greece 15 August 2009
Contents lists available at ScienceDirect
The Breast journal homepage: www.elsevier.com/brst
Letter to the Editor
Bisphosphonate osteonecrosis of the jaws in cancer patients
Sir, We read with interest the review article by Fehm et al1 reporting the recommendations of the multidisciplinary task force on behalf of the German society of senology. The authors report that in comparison to patients with bone metastases, breast-cancer patients receiving adjuvant bisphosphonates with a less frequent dosing schedule are at a substantially lower risk of developing osteonecrosis of the jaws (ONJ). This information derives from a number of manufacturer-sponsored clinical trials summarized in Table 1 of their manuscript.1 This is accurate; however one should consider that the incidence of osteonecrosis of the jaws was also reported to be negligible in manufacturer-sponsored clinical trials of bisphosphonates performed in patients with bone metastasis.2 Fehm et al. report that there is currently no profound evidence that any specific malignant disease would present an increased risk for ONJ.1 In this regard, a longitudinal cohort study of multiple myeloma, breast and prostate cancer patients, where ONJ was the primary end-point, has recently been published. The latter study demonstrated that type of malignant disease is not associated with increased ONJ incidence, through a multivariate model which controlled for sex, age, smoking status, history of dental work and type of bisphosphonate administered.3
0960-9776/$ – see front matter Ó 2009 Elsevier Ltd. All rights reserved. doi:10.1016/j.breast.2009.09.003
References 1. Fehm T, Felsenberg D, Krimmel M, Solomayer E, Wallwiener D, Hadjii P. Bisphosphonate-associated osteonecrosis of the jaw in breast cancer patients: recommendations for prevention and treatment. Breast; 2009;18(4):213–7. 2. Kyrgidis A. Bisphosphonate-related osteonecrosis of the jaw in randomized clinical trials. Breast Cancer Res Treat; 2009; doi:10.1007/s10549-009-0466-2. 3. Vahtsevanos K, Kyrgidis A, Verrou E, et al. Bisphosphonate related osteonecrosis of the jaws: a longitudinal cohort study of risk factors in cancer patients. J Clin Oncol; 2009; doi:10.1200/JCO.2009.21.9584.
Athanassios Kyrgidis* Department of Oral and Maxillofacial Surgery, Theagenio Cancer Hospital, 3 Papazoli St., 54630 Thessaloniki, Greece Corresponding author. Tel.: þ30 6947566727; fax: þ30 2310546701. E-mail address: [email protected] Charalambos Andreadis 3rd Department of Clinical Oncology, Theagenio Cancer Hospital, 2 A. Simeonidi St., 54639 Thessaloniki, Greece 15 August 2009