In an Austrian study reported in the Journal of Clinical Oncology, Brunner et al identified the incidence of medication-related osteonecrosis of the jaw over 20 years of follow-up in patients with breast cancer who had bone metastases and were receiving antiresorptive medication.
Study Details and Key Findings
The study involved data on patients with breast cancer from all nine breast centers in the state of Tyrol from 2000 to 2020.
Among 8,869 patients diagnosed with breast cancer, 639 had breast cancer and bone metastases and had received antiresorptive therapy once per month with no de-escalation of therapy. Among the 639 patients, 292 (45.7%) received denosumab only, 255 (39.9%) received bisphosphonates only, and 92 (14.4%) received bisphosphonates and denosumab sequentially.
Medication-related osteonecrosis of the jaw incidence in breast cancer patients with bone metastases was found to be considerably higher, especially for patients receiving denosumab, when compared with available data in the literature. Additionally, patients treated with denosumab developed medication-related osteonecrosis of the jaw significantly earlier.— Brunner et al
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Among the 639 patients, medication-related osteonecrosis of the jaw was diagnosed in 56 (8.8%, 95% confidence interval [CI] = 6.6%–11.0%); as noted by the investigators, the 8.8% incidence rate is “considerably higher … compared with data published in the international literature so far.” The incidence of medication-related osteonecrosis of the jaw was 11.6% (95% CI = 8.0%–15.3%) in patients receiving denosumab only, 2.8% (95% CI = 0.7%–4.8%) in those receiving bisphosphonates only, and 16.3% (95% CI = 8.8%–23.9%) in those receiving bisphosphonates followed by denosumab.
Median time to onset of medication-related osteonecrosis of the jaw from the start of treatment was 4.6 years (interquartile range [IQR] = 1.6–9.6 years) for patients receiving denosumab only, 5.1 years (IQR = 2.9–7.1 years) for those receiving bisphosphonates only, and 8.4 years (IQR = 5.3–9.6 years) for those receiving bisphosphonates followed by denosumab.
The investigators concluded, “Medication-related osteonecrosis of the jaw incidence in breast cancer patients with bone metastases was found to be considerably higher, especially for patients receiving denosumab, when compared with available data in the literature. Additionally, patients treated with denosumab developed medication-related osteonecrosis of the jaw significantly earlier.”
Christine Brunner, MD, of the Department of Obstetrics and Gynecology, Medical University of Innsbruck, Innsbruck, Austria, is the corresponding author for the Journal of Clinical Oncology article.
Disclosure: For full disclosures of the study authors, visit ascopubs.org.
