International Journal of Cancer | 2019
Osimertinib and jaw osteonecrosis? A case report
Abstract
Dear Sir, We are writing in response to the recent publication “Efficacy and safety of osimertinib in treating EGFR-mutated advanced NSCLS: A meta-analysis,” that cataloged various reported adverse events in association with osimertinib. We report observing delayed/aberrant healing following dental extractions performed in a patient who had recently initiated treatment with osimertinib (Tagrisso, AstraZeneca US, Wilmington, DE) for bone-metastatic nonsmall cell lung cancer (NSCLC). The patient, a 75-year-old woman with a history of hypertension and hypothyroidism, experienced a pathological fracture of her left hip (Fig. 1). This led to the diagnosis of a primary NSCLC lesion in the upper lobe of her left lung and bone metastases involving her left hip (Fig. 2). The L858R mutation in exon 21 of the EGFR gene was detected in the metastatic lesion biopsied during the hip arthroplasty procedure. The patient was initiated on osimertinib therapy and 3 weeks later, presented to our dental clinic for evaluation and dental clearance before initiating intravenous bisphosphonate therapy for managing bone metastases. The patient had extensive, nonrestorable dental caries in her remaining dentition (Figs. 3a and 3b). Extractions of all of her remaining root tips and residual teeth were recommended to eliminate dental disease and reduce future risk of jaw osteonecrosis from the planned antiresorptive therapy. To expedite dental clearance for commencing intravenous bisphosphonate therapy, it was decided that all the extractions would be performed during one appointment. During the extractions visit, the particular ease of the dental extractions was notable, considering that the patient had no appreciable periodontal disease-related bone loss. However, at the 1-week postoperative visit, the patient complained of “bone pieces sticking out” in the sites of dental extraction. Intraoral examination revealed no signs of purulence, swelling or erythematous soft tissue suggestive of acute infection. However, the dentoalveolar bone appeared necrotic and exposed in multiple areas in the extraction sites. The exposed necrotic areas were curetted until hard bone with good bleeding response was encountered, under local anesthesia. The soft tissue was approximated to achieve primary closure over the curetted sites. Healing was uneventful and expeditious after the debridement.