Recently published reports have suggested that antiangiogenic drugs such as
sunitinib could potentiate the
osteonecrosis of the jaw (ONJ) induced by
bisphosphonates (BPs) and even induce this adverse effect per se. We reported a case of ONJ with
renal cell carcinoma under
sunitinib medication and history of BPs
therapy. A 53-year-old man was referred to the
oral surgery clinic complaining of painful exposed oral lesion and bone extraction from right lower jaw in the mouth. He underwent
nephrectomy followed by 5 months treatment with cycles of 50 mg
sunitinib (Sutent®) once a day for 4 weeks followed by 2 weeks drug free before lesion exposure in October 2016. However, the patient has encounter to intermittent
mucositis and
gingivitis in oral cavity several times. Our patient had a history of
zoledronic acid (4 mg intravenously two times) administration due to primary
cancer misdiagnosis. In our case, no dental procedure contributed to the occurrence of ONJ. The lesion was improved by
sunitinib cessation and administration of
antibiotics through 2 weeks. Mucosal injury induction as well as inhibition of angiogenic signaling pathways by
sunitinib administration may have precipitated the occurrence of ONJ. In addition, a possible synergistic effect by previously BP treatment is another accused.