Higher incidence of Osteonecrosis of the Jaw (ONJ) in patients with metastatic castration resistant prostate cancer treated with anti-angiogenic agents

Cancer Invest. 2009 Feb;27(2):221-6. doi: 10.1080/07357900802208608.


ONJ is an important toxicity in cancer patients receiving bisphosphonate therapy. Here we report a higher than usual incidence of ONJ, 11 of 60 (18.3%, 95% Confidence Interval, CI: 9%-28%) patients enrolled in a phase II clinical trial combining bevacizumab, docetaxel, thalidomide, and prednisone (ATTP) in chemotherapy-naive men with metastatic castration resistant prostate cancer (mCRPC). The use of bisphosphonates was allowed at study entry. Our study suggests that anti-angiogenic and chemotherapy agents can predispose to the development of ONJ in men with mCRPC on zoledronic acid. Imaging modalities, such as bone scans, may be useful in following the clinical course of patients who develop ONJ.

Publication types

  • Clinical Trial, Phase II
  • Research Support, N.I.H., Intramural

MeSH terms

  • Adult
  • Aged
  • Alendronate / adverse effects
  • Angiogenesis Inhibitors / therapeutic use*
  • Diphosphonates / adverse effects*
  • Humans
  • Ibandronic Acid
  • Incidence
  • Jaw Diseases / chemically induced
  • Jaw Diseases / epidemiology*
  • Male
  • Middle Aged
  • Neoplasm Metastasis
  • Osteonecrosis / chemically induced
  • Osteonecrosis / epidemiology*
  • Prostatic Neoplasms / complications
  • Prostatic Neoplasms / drug therapy*
  • Prostatic Neoplasms / pathology


  • Angiogenesis Inhibitors
  • Diphosphonates
  • Ibandronic Acid
  • Alendronate