Osteonecrosis of the Jaw in Myeloma Patients Receiving Denosumab or Zoledronic Acid. A Commentary of the Pivotal Trial by Raje et al. Published on Lancet Oncology

Vittorio Fusco; Giuseppina Campisi; Paul de Boissieu; Federico Monaco; Anna Baraldi; Gianmauro Numico; Alberto Bedogni

doi:10.3390/dj6030042

Osteonecrosis of the Jaw in Myeloma Patients Receiving Denosumab or Zoledronic Acid. A Commentary of the Pivotal Trial by Raje et al. Published on Lancet Oncology

Dent J (Basel). 2018 Sep 1;6(3):42. doi: 10.3390/dj6030042.

Authors

Vittorio Fusco¹, Giuseppina Campisi², Paul de Boissieu³, Federico Monaco⁴, Anna Baraldi⁵, Gianmauro Numico⁶, Alberto Bedogni⁷

Affiliations

¹ Oncology Unit, Azienda Ospedaliera di Alessandria, 15121 Alessandria, Italy. vfusco@ospedale.al.it.
² Oral Medicine Unit, Università di Palermo, 90127 Palermo, Italy. campisi@odonto.unipa.it.
³ Service D'épidémiologie et de Santé Publique, Hôpitaux Universitaires Paris-Sud, 94270 Paris, France. paul.de-boissieu@u-psud.fr.
⁴ Haematology Unit, Azienda Ospedaliera di Alessandria, 15121 Alessandria, Italy. monacofederico.ospedale@gmail.com.
⁵ Haematology Unit, Azienda Ospedaliera di Alessandria, 15121 Alessandria, Italy. abaraldi@ospedale.al.it.
⁶ Oncology Unit, Azienda Ospedaliera di Alessandria, 15121 Alessandria, Italy. gianmauro.numico@ospedale.al.it.
⁷ Regional Center for Prevention, Diagnosis and Treatment of Medication and Radiation-Related Bone Diseases of the Head and Neck, University of Padua, 35136 Padua, Italy. alberto.bedogni@unipd.it.

Abstract

The recent randomized trial, published by Raje et al., on Lancet Oncology is potentially practice changing. It proposes that denosumab is a valid alternative to zoledronic acid in the treatment of myeloma patients. However, several points need further data and more details, such as information on incidence, diagnosis, and follow-up of osteonecrosis of the jaw (ONJ) cases, observed among treated patients. Adopted definition to adjudicate ONJ cases, type of registration of potential ONJ cases, length of observation are possible causes of potential underestimation of ONJ incidence in their study. Future updated evaluations with longer follow-up, and including actuarial estimation, are required for final judgment on ONJ risk in myeloma patients receiving denosumab, and comparison with ONJ risk by zoledronic acid.

Keywords: MRONJ; ONJ; denosumab; jaw; medication-related osteonecrosis of the jaw; multiple myeloma; osteonecrosis; osteonecrosis of the jaw; zoledronic acid.