Determinants of outcome in cancer patients with medication-related osteonecrosis of the jaw: A 19-year retrospective study

Objective Medication-related osteonecrosis of the jaw (MRONJ) is a well-established complication associated with antiresorptive agents. While risk factors associated with MRONJ onset have been described, there is limited data on factors related to resolution. The purpose of this study is to identify risk factors that may influence resolution of MRONJ in cancer patients treated with antiresorptive therapy. Methods Following approval by the institutional Review Board of Memorial Sloan Kettering Cancer Center (MSKCC), the treatment records of 433 patients with MRONJ from 2003-2022 were retrospectively reviewed to include patients treated with the antiresorptive agents (pamidronate, zoledronic acid or denosumab) with a minimum follow up of one month post MRONJ diagnosis. The clinical outcome at the last follow up was recorded as resolved versus not resolved. Resolved was defined as complete mucosal coverage and lack of symptoms. Not Resolved was defined as persistence of any stage of MRONJ according to the AAOMS classification system. Factors related to patient and tumor characteristics were examined and statistical analysis was performed to assess for potential association with healing. Competing risks methods were used to analyze time to MRONJ resolution with death as a competing event. Results A total of 300 patients were included for analysis. The median follow-up time was 94.9 months (95% CI 62.8, 176.6). The preliminary data analysis showed that at the last dental follow up, 195 patients were not resolved and 105 were resolved. The cumulative incidence of MRONJ resolution was 33% (95% CI 27%, 38%) at 3 years and 37% (95% CI 31%, 42%) at 5 years. Statistically significant factors associated with resolution included a primary diagnosis of multiple myeloma (p=.005), male gender (p=.014), exposed bone less than 1cm at initial presentation (p=.044), and location limited to a single arch (p=.035). Additional analysis is currently underway. Conclusions This is the largest single institution study to evaluate determinants associated with MRONJ outcomes in cancer patients treated with antiresorptive agents over a 19-year period. Our initial data indicates that primary cancer diagnosis, gender, and size of lesion influence healing propensity in the cancer patient with MRONJ secondary to treatment related antiresorptive medication. Medication-related osteonecrosis of the jaw (MRONJ) is a well-established complication associated with antiresorptive agents. While risk factors associated with MRONJ onset have been described, there is limited data on factors related to resolution. The purpose of this study is to identify risk factors that may influence resolution of MRONJ in cancer patients treated with antiresorptive therapy. Following approval by the institutional Review Board of Memorial Sloan Kettering Cancer Center (MSKCC), the treatment records of 433 patients with MRONJ from 2003-2022 were retrospectively reviewed to include patients treated with the antiresorptive agents (pamidronate, zoledronic acid or denosumab) with a minimum follow up of one month post MRONJ diagnosis. The clinical outcome at the last follow up was recorded as resolved versus not resolved. Resolved was defined as complete mucosal coverage and lack of symptoms. Not Resolved was defined as persistence of any stage of MRONJ according to the AAOMS classification system. Factors related to patient and tumor characteristics were examined and statistical analysis was performed to assess for potential association with healing. Competing risks methods were used to analyze time to MRONJ resolution with death as a competing event. A total of 300 patients were included for analysis. The median follow-up time was 94.9 months (95% CI 62.8, 176.6). The preliminary data analysis showed that at the last dental follow up, 195 patients were not resolved and 105 were resolved. The cumulative incidence of MRONJ resolution was 33% (95% CI 27%, 38%) at 3 years and 37% (95% CI 31%, 42%) at 5 years. Statistically significant factors associated with resolution included a primary diagnosis of multiple myeloma (p=.005), male gender (p=.014), exposed bone less than 1cm at initial presentation (p=.044), and location limited to a single arch (p=.035). Additional analysis is currently underway. This is the largest single institution study to evaluate determinants associated with MRONJ outcomes in cancer patients treated with antiresorptive agents over a 19-year period. Our initial data indicates that primary cancer diagnosis, gender, and size of lesion influence healing propensity in the cancer patient with MRONJ secondary to treatment related antiresorptive medication.