Faculty Disclosure TO DO OR NOT TO DO THE DENTAL EXTRACTION IN CANCER PATIENTS, WHO RECEIVE BONE TARGETED AGENTS (BTAS):

Transcription

1 TO DO OR NOT TO DO THE DENTAL EXTRACTION IN CANCER PATIENTS, WHO RECEIVE BONE TARGETED AGENTS (BTAS): A SYSTEMATIC REVIEW, BSG, MASCC, PART 1. Faculty Disclosure No, nothing to disclose Yes, please specify:

2 E. Vardas 1, O. Nicolatou-GaliGs 1, E. Papadopoulou 1, M. Kouri 1, D. GaliG 2, S. Torres 3, V. Fusco 4, C. EsGlo 5, D. Saunders 6, J.J. Body 7, C. MiglioraG 8, R. Lalla 9. accepted as a Proffered Paper 1 Na%onal and Kapodistrian University of Athens- Dental School, Clinic of Hospital Den%stry, Athens, Greece. 2 Na%onal and Kapodistrian University of Athens- Dental School, Department of Oral Diagnosis & Radiology, Athens, Greece. 3 Clemen%no Fraga Filho University Hospital- Universidade Federal do Rio de Janeiro, Departmento of Oral Pathology and Diagnosis, Rio de Janeiro, Brazil. 4 Azienda Ospedaliera di Alessandria, Oncology Unit, Alessandria, Italy. 5 Memorial Sloan KePering Cancer Center, Department of Surgery, New York, USA. 6 Northern Ontario School of Medicine Northeast Cancer Centre- Health Sciences North, Department of Dental Oncology, Ontario, Canada. 7 University Libre de Bruxelles- CHU Brugmann- Bruxelles- Belgium, Department of Medicine, Bruxelles, Belgium. 8 University of Florida College of Den%stry, Department of Oral and Maxillofacial Diagnos%c Sciences, Florida, USA. 9 University of Connec%cut- School of Dental Medicine- Farmington- CT- USA, Department of Oral Medicine, Connec%cut, USA.

3 IntroducGon: Dental extracgon is considered the main local risk factor (45%-70%) for the development of ONJ in cancer pagents, who receive BTAs. However the actual risk of ONJ aber a dental extracgon is not clear. Dr. Migliorati and his colleagues are currently collaborating with a group in Greece on this topic. We want to publish proof that dental extractions do not cause osteonecrosis of the jaw but expose the alveolar bone, which may already be necrotic, he said.

4 Aim of the study: To review the risk of ONJ development following dental extracgons in cancer pagents, who receive BTAs.

5 Inclusion criteria: ArGcles which report on pagents who receive ONJ-related medicagons for cancer Clinical research papers tesgng the specific quesgons ArGcles published in a peer-reviewed journal, ArGcles indexed in Medline between 1st January 2009 to 31st December 2016 Adult pagents Exclusion criteria: ArGcles, which report on pagents, who receive ONJ-related medicagons for osteoporosis or other benign disease, argcles, which include pagents with cancer and pagents with benign condigons, assessed as one group ArGcles that do not report tesgng on the specific quesgons literature reviews (literature reviews would be checked for ar4cles interes4ng to our review) ArGcles published in a language other than English - abstracts presented in MeeGngs - not full argcle published.

6 Pubmed and Embase were searched. A manual search of the bibliography of idengfied published argcles was also performed. Personal communicagon with relevant experts was conducted The published literature was crigcally evaluated and graded based on quality of evidence. All assessments were made by two reviewers An Excel form, kindly provided by the MASCC MucosiGs Study Group, was modified accordingly for our review

7 6249 retrieved %tles 579 selected %tles 144 selected abstracts 106 full ar%cles selected 60 included ar%cles 4 argcles ONJ related to dental extracgons ONJ related to non-angresorpgve targeted therapies ONJ management

8 breast cancer, 20 non hodgkin lympoma, 1 lung cancer, 2 mulgple myeloma, 34 [CATEGORY NAME], [VALUE] Four argcles (2 case series, 1 retrospecgve and one prospecgve study) 255 dental extracgons were performed in 126 pagents (mean age 61.7 years) All pagents received zoledronic acid; 3 pagents also received pamidronate. The reason for dental extracgons was available in 92 of 255 cases (36,1%) either due to periodontal disease or dental caries. Zoledronic acid was discongnued in 64 (50,8%) pagents during 92 extracgons (mean Gme 47.1 days).

9 Author Type of cancer N (%) Comorbidities N (%) ECOG performance status N (%) Smoker N (%) Chemotherapy N (%) Corticosteroids N (%) Antiresorptive therapy N (%) Duration median time (range) Reason for antiresorpti ve therapy Mücke 2016 prostate cancer 253 (100%) Not reported 0 group A: 64 (39%) 0group B: 36 (40%) 1 group A: 95 (58] 1group B: 52 (57.8%) 2 group A: 4 (2.4%) 2group B: 2 (2.2%) group A: 17 (10%) group B: 12 (13%) Not reported Not reported zoledronic acid 253 (100%) Not reported Metastatic disease kato 2013 Breast Cancer 11 (55%) Multiple Myeloma 05 (25%) Prostate Cancer 03 (15%) Non-Hodgkin Lymphoma 01 (05%) Not reported Not reported Not reported Not reported 09 (45%) zoledronic acid 14 (65%) pamidronate 06 (30%) Zoledronate/ Pamidronate 01 (05%) 5 months (1-60 months) 13months (1-85 months) Not reported Metastatic disease Kan 2011 Breast Cancer 1 (50%) Multiple Myeloma 1 (50%) Not reported Not reported Not reported 2 (100%) No zoledronic acid 2 (100%) Not reported Metastatic disease Ferlito 2011 Multiple myeloma 28 (65,1%) Breast cancer 8 (18,6%) Prostate cancer 5 (11,6%) Lung cancer Not reported Not reported Not reported Not reported Not reported zoledronic acid 43(100%) 16.2 months (13-19,4) Metastatic disease

10 Issues to address????? Antiresorptives/Targeted therapies interruption Redose of antiresorptives/targeted therapies Dental extraction wound management