Can Docetaxel Concomitant Administration with Bisphosphonates be Considered as a Risk Factor for Osteonecrosis of the Jaw in Metastatic Breast Cancer Patients? A Preliminary Study

Osteonecrosis of the jaws (ONJ) is rare complication of bisphosphonates use which was described for the first time by Marx in 2004. Bisphosphonates (BP) are stable derived of inorganic pyrophosphate which had an antiresorbant effect in the bone making them very useful in bone metastasis, especially with the third generation of bisphosphonates. Many risk and trigger factors have been described as predisposing to the development of ONJ. The aim of this work is to show if docetaxel administration can be considered as a predisposing factor to develop ONJ. We report a series of 11 patients treated during 5 years in the maxillofacial surgery department in HU Habib Bourguiba Sfax – Tunisia for ONJ due to BP use for breast cancer bone metastasis. Those patients were divised into two sub-groups: with and without concomitant docetaxel administration. All patients’ data (age and delay of appearance of ONJ, cumulative doses and trigger factors) were collected and analyzed. It was found that patients treated with docetaxel in association to bisphosphonates developed ONJ in earlier age, with a lower cumulative doses of zoledronic acid within a shorter delay period. ONJ occurred in these patients even in the absence of trigger factor and intrinsic risk factors.