LETTER TO THE EDITOR
Medication-related osteonecrosis of the jaw incidence
in patients exposed concomitantly to bone resorption inhibitors
and vascular endothelial growth factor receptor tyrosine kinase
inhibitors: is it generalizable to all solid tumors?
Received: 17 February 2018 /Accepted: 27 May 2018
Springer-Verlag GmbH Germany, part of Springer Nature 2018
To the Editor,
I wish to congratulate van Cann and their colleagues in
which they investigated medication-related osteonecrosis
of the jaw (MRONJ) incidence in patients exposed con-
comitantly to bone resorption inhibitors (BRIs) and vas-
cular endothelial growth factor receptor tyrosine kinase
inhibitors (VEGFR-TKIs). They concluded that patients
receiving concomitant treatment with VEGFR-TKIs and
BRIs have a five to ten times higher risk for development
of MRONJ compared to patients treated with BRIs alone.
However, 86.7 and of 1.9% of all patients in study group
(BRIs + VEGFR-TKIs) and control groups (BRIs only)
were diagnosed with renal cell carcinoma, respectively.
Therefore, it is not generalizable to conclude that concom-
itant treatment with VEGFR-TKIs and BRIs increase
MRONJ incidence in all solid tumors. Actually, incidence
rates of MRONJ in both control and study arms were
almost similar (10.9 vs. 11.1%, p = 0.95) in the longer
Compliance with ethical standards
Conflict of interest The author has no conflict of interest.
1. van Cann T, Loyson T, Verbiest A, Clement PM, Bechter O, Willems
L et al (2018) Incidence of medication-related osteonecrosis of the
jaw in patients treated with both bone resorption inhibitors and vas-
cular endothelial growth factor receptor tyrosine kinase inhibitors.
Support Care Cancer 26(3):869–878
* Kadri Altundag
MKA Breast Cancer Clinic, Tepe Prime, Cankaya,
06800 Ankara, Turkey
Supportive Care in Cancer