Researchers determine how often cancer patients develop osteonecrosis of the jaw

December 17, 2020

PORTLAND, OR - A landmark study by researchers from the SWOG Cancer Research Network, a cancer clinical trials group funded by the National Cancer Institute (NCI), part of the National Institutes of Health (NIH), has found that 2.8 percent of patients on average develop osteonecrosis of the jaw, or ONJ, within three years of starting a common treatment for cancer that has spread to the bone.

Appearing in JAMA Oncology, the findings are important because the treatment, zoledronic acid, is prescribed to tens of thousands of patients whose cancer has spread to the bone. Almost all forms of cancer can spread, or metastasize, to bone but the most common are lung, breast, and prostate cancers and multiple myeloma. Zoledronic acid can protect bone, but is associated with a risk of ONJ, which causes exposed bone in the jaw that does not heal. This causes inflammation and pain in the mouth, and people with ONJ may have trouble speaking, eating, and smiling - small everyday acts that play a big role in patients' quality of life.

No prior studies had reliably determined how common ONJ is. The SWOG study is the first, and largest, to follow cancer patients over time to determine the incidence of ONJ as well as its risk factors. It was conducted by SWOG through the NCI's National Clinical Trials Network and its NCI Community Oncology Research Program.

Catherine Van Poznak, MD, the co-chair of the study, known as S0702, and a breast cancer physician at the University of Michigan Rogel Cancer Center, said an estimated 280,000 adults in the U.S. live with metastatic bone disease. If they're all treated with zoledronic acid, according to S0702 findings, about 7,840 will develop ONJ in three years.

"Until now, we've never had good estimates of how many cancer patients get ONJ, and we've found that while a small percentage develop the condition, a significant number of people are at risk of being affected," Van Poznak said. "It's important for physicians and patients to have a better understanding not only of the incidence of ONJ, but what the risk factors are and how it impacts patients."

Bone health is a major issue in cancer care, and zoledronic acid is the most frequently prescribed protective agent to treat bone metastases. The drug is beneficial because it reduces cancer's ability to break down bone, a process that unfortunately also can cause fractures, pain, and other complications.

Van Poznak and her SWOG colleagues wanted to understand ONJ better, and launched S0702, a large-scale, prospective study designed to determine the incidence of the disease in cancer patients and to learn more about risk factors and impact on quality of life.

A total of 3,571 participants from 172 sites were registered onto the trial, and 3,491 patients were evaluated in the final results. All had metastatic bone disease and were prescribed zoledronic acid within 30 days of joining the study. Most of the patients had breast, prostate, lung cancers or multiple myeloma. In the study, medical, dental, and patient-reported outcome (PRO) forms were collected every six months. If patients were diagnosed with ONJ while participating in the trial, the dental exam was conducted and the paperwork was submitted every three months. Patients were followed for three years.

The key findings: Van Poznak said the findings may provide evidence to support less frequent use of zoledronic acid - such as every 12 weeks - to reduce the risk of cancer patients developing ONJ.
-end-
S0702 was supported by the NIH through NCI award CA189974 and also in part by Novartis.

The study team included Joseph M. Unger, PhD, SWOG Statistics and Data Management Center; Amy Darke, MS, SWOG Statistics and Data Management Center; Carol Moinpour, PhD, Fred Hutchinson Cancer Research Center; Robert A. Bagramian, DDS, PhD, University of Michigan School of Dentistry; Mark M. Schubert, DDS, MSD, University of Washington School of Dentistry; Lisa Kathryn Hansen, RN, MS, Legacy Good Samaritan Hospital; Justin D. Floyd, DO, FACOI, Heartland NCORP; Shaker R. Dakhi, Wichita NCORP; Danika L. Lew, SWOG Statistics and Data Management Center; James Lloyd Wade III, MD, Cancer Care Specialists of Illinois; Michael J. Fisch, MD, MPH, University of Texas MD Anderson Cancer Center; N. Lynn Henry, MD, PhD, University of Michigan Rogel Cancer Center; Dawn L. Hershman, MD, MS, NewYork-Presbyterian/Columbia University Irving Medical Center's Herbert Irving Comprehensive Cancer Center; and Julie Gralow, MD, of University of Washington, Fred Hutchinson Cancer Research Center, and Seattle Cancer Care Alliance.

SWOG

Related Cancer Articles from Brightsurf:

New blood cancer treatment works by selectively interfering with cancer cell signalling
University of Alberta scientists have identified the mechanism of action behind a new type of precision cancer drug for blood cancers that is set for human trials, according to research published in Nature Communications.

UCI researchers uncover cancer cell vulnerabilities; may lead to better cancer therapies
A new University of California, Irvine-led study reveals a protein responsible for genetic changes resulting in a variety of cancers, may also be the key to more effective, targeted cancer therapy.

Breast cancer treatment costs highest among young women with metastic cancer
In a fight for their lives, young women, age 18-44, spend double the amount of older women to survive metastatic breast cancer, according to a large statewide study by the University of North Carolina at Chapel Hill.

Cancer mortality continues steady decline, driven by progress against lung cancer
The cancer death rate declined by 29% from 1991 to 2017, including a 2.2% drop from 2016 to 2017, the largest single-year drop in cancer mortality ever reported.

Stress in cervical cancer patients associated with higher risk of cancer-specific mortality
Psychological stress was associated with a higher risk of cancer-specific mortality in women diagnosed with cervical cancer.

Cancer-sniffing dogs 97% accurate in identifying lung cancer, according to study in JAOA
The next step will be to further fractionate the samples based on chemical and physical properties, presenting them back to the dogs until the specific biomarkers for each cancer are identified.

Moffitt Cancer Center researchers identify one way T cell function may fail in cancer
Moffitt Cancer Center researchers have discovered a mechanism by which one type of immune cell, CD8+ T cells, can become dysfunctional, impeding its ability to seek and kill cancer cells.

More cancer survivors, fewer cancer specialists point to challenge in meeting care needs
An aging population, a growing number of cancer survivors, and a projected shortage of cancer care providers will result in a challenge in delivering the care for cancer survivors in the United States if systemic changes are not made.

New cancer vaccine platform a potential tool for efficacious targeted cancer therapy
Researchers at the University of Helsinki have discovered a solution in the form of a cancer vaccine platform for improving the efficacy of oncolytic viruses used in cancer treatment.

American Cancer Society outlines blueprint for cancer control in the 21st century
The American Cancer Society is outlining its vision for cancer control in the decades ahead in a series of articles that forms the basis of a national cancer control plan.

Read More: Cancer News and Cancer Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.