Osteonecrosis of the Jaw in a Patient Treated with Denosumab and Temsirolimus

The number of osteonecrosis related medications of the jaw is constantly increasing, as is apparent from the many molecular target and immunological drugs in the last years introduced in the cancer treatment. In addition to bisphosphonates and denosumab, recently cases due to bevacizumab, sunitinib and ipilimumab have been described. The inhibition of the bone resorption and the angiogenesis block plays a fundamental role in the physiopathology of the osteonecrosis of the jaw. Also, the mammalian target of rapamycin pathway, through the reduced production of the hypoxia-inducible factors and the vascular endothelial growth factor, leads to the inhibition of angiogenesis. In this work, we report a case of ONJ during denosumab and temsirolimus treatment in a patient with metastatic renal cancer, in which temsirolimus may have played a role of contributory cause, synergizing the effect of the denosumab, in the development and maintenance of the bone necrosis.