Osteonecrosis of the jaws in patients assuming bisphosphonates and sunitinib: two case reports.

Osteonecrosis of the jaw (ONJ) is an unremitting adverse outcome associated with bisphosphonate therapy, primarily intravenously administered, in patients with bone metastases from solid tumors, multiple myeloma and os - teometabolic diseases. From 2003 many cases of bisphosphonates related osteonecrosis of the jaw (BRONJ) have been reported in literature. Sunititnib is a novel anticancer agent used in gastrointestinal cancers and renal cancers resis - tant to imatinib. Recent reports describe the onset of ONJ in patients treated with both sunitinib and bispho - sponates. A case of osteonecrosis of the jaw related to sunitinib, without association of bisphosphonate (BP) medications has been recently reported. A recent hypothesis suggests that antiangio - genic drugs such as sunitinib could cause ONJ even without the association with BPs. We describe a case of two patients affected by renal carcinoma under BP and sunitinib med - ication who developed stage III bisphospho - nates-related osteonecrosis of the jaw (BRONJ) .