Gingival bleeding and jaw bone necrosis in patients with metastatic renal cell carcinoma receiving sunitinib: report of 2 cases with clinical implications

Oral Surg Oral Med Oral Pathol Oral Radiol. 2012 Feb;113(2):234-8. doi: 10.1016/j.tripleo.2011.08.024. Epub 2012 Jan 20.

Abstract

There is emerging evidence that oral mucositis/stomatitis is a common adverse effect of sunitininb antiangiogenic therapy in patients with metastatic renal cell carcinoma (mRCC). In addition, a case of sunitinib-related jaw osteonecrosis was recently described. We report on 2 patients with mRCC treated with sunitinib. The first patient, a 19-year-old woman, treated with cisplatin and sunitinib, presented with oral pain, malodor, spontaneous and continuous gingival bleeding, and painful necrotic ulcerations clinically resembling necrotizing ulcerative gingivitis (NUG). Suntinib-related stomatitis and bleeding were considered cumulative to NUG symptoms. The second patient, a 64-year-old woman, treated with sunitinib only, complained of mandibular pain. Sunitinib-related jaw osteonecrosis was diagnosed. Gingival bleeding and soft tissue necrosis, as well as jaw osteonecrosis may develop as adverse events of sunitinib use. Antiangiogenic therapies are increasingly used in the treatment of cancers. The presented cases are aimed to alert health care professionals on adverse oral events.

Publication types

  • Case Reports

MeSH terms

  • Angiogenesis Inhibitors / adverse effects
  • Antineoplastic Agents / adverse effects*
  • Antineoplastic Agents / therapeutic use
  • Carcinoma, Renal Cell / complications
  • Carcinoma, Renal Cell / drug therapy
  • Female
  • Gingival Hemorrhage / chemically induced
  • Gingival Hemorrhage / etiology*
  • Gingival Hemorrhage / therapy
  • Humans
  • Indoles / adverse effects*
  • Indoles / therapeutic use
  • Kidney Neoplasms / complications
  • Kidney Neoplasms / drug therapy
  • Mandibular Diseases / chemically induced
  • Mandibular Diseases / etiology*
  • Mandibular Diseases / therapy
  • Middle Aged
  • Neoplasm Metastasis
  • Osteonecrosis / chemically induced
  • Osteonecrosis / etiology*
  • Osteonecrosis / therapy
  • Pyrroles / adverse effects*
  • Pyrroles / therapeutic use
  • Sunitinib
  • Treatment Outcome
  • Young Adult

Substances

  • Angiogenesis Inhibitors
  • Antineoplastic Agents
  • Indoles
  • Pyrroles
  • Sunitinib