http://media.onj.nu/2013/08/AAOMS-Position-paper-ONJ_2014.pdf

American Association of Oral and Maxillofacial Surgeons position paper on medication-related osteonecrosis of the jaw--2014 update.

Strategies for management of patients with, or at risk for, medication-related osteonecrosis of the jaw (MRONJ) were set forth in the American Association of Oral and Maxillofacial Surgeons (AAOMS) position papers in 2007 and 2009. The position papers were developed by a special committee appointed by the board and composed of clinicians with extensive experience in caring for these patients and basic science researchers. The knowledge base and experience in addressing MRONJ has expanded, necessitating modifications and refinements to the previous position paper. This special committee met in September 2013 to appraise the current literature and revise the guidelines as indicated to reflect current knowledge in this field. This update contains revisions to diagnosis, staging, and management strategies and highlights current research status. The AAOMS considers it vitally important that this information be disseminated to other relevant health care professionals and organizations.

/pdf/medication-related-osteonecrosis-of-the-jaw-2014-update-3hc2jz97vd.pdf

Medication-Related Osteonecrosis of the Jaw—2014 Update

A 59-year-old male patient was referred to the hospital with exposed bone measuring 10 mm in diameter in the posterior, left-side region of the lower jaw. Two months previous, the first molar had been extracted. The patient had contracted renal cell carcinoma and had been treated by nephrectomy in 2003. Soft tissue metastases occurred. After initial therapy with interferon and vinblastine, a relapse occurred and the therapy was changed to sorafenib, followed by sunitinib. Osteonecrosis of the lower jaw appeared 1 year after initial and exclusive therapy with sunitinib. Bisphosphonates had never been applied. With increasing application of multi-kinase inhibitors, complications due to osteonecrosis could occur more frequently.

Osteonecrosis of the jaw related to sunitinib

A 58-year-old woman presented to the Oral and Maxillofacial Surgery Clinic experiencing severe limited mouth opening and exposed bone in the socket of the right mandibular third molar 8 months following the extraction of the tooth. The patient had been treated during the year before her presentation with sunitinib, an antiangiogenic drug, for renal cell carcinoma. The clinical, radiographic, and histologic picture of a chronic nonhealing extraction socket was consistent with osteonecrosis of the jaw (ONJ), although she had never been treated with bisphosphonates or corticosteroids. The treatment with sunitinib was discontinued and the patient was treated with antibiotics and physiotherapy for 12 weeks with complete recovery. Sunitinib may cause osteonecrosis of the jaw after oral surgical interventions with no previous exposure to bisphosphonates. The pathogenesis may be related to its antiangiogenic mechanism and impaired wound healing. Full recovery may require long-term cessation of the insulting drug combined with prolonged antibiotic treatment.

Sunitinib related osteonecrosis of jaw: a case report.

Osteonecrosis of the jaw under bisphosphonate and antiangiogenic therapies: cumulative toxicity profile?

<h3>Background and Importance</h3> Excessive waiting time is one of the main causes of patient dissatisfaction in oncologic daily care unit (DCU). Lean management, dose banding, advanced prescription and automatisation are usually used in our hospital to improve patient care pathway. In our adult DCU (&gt;26 000 patients/years), patients have to wait for their treatment less than an hour. <h3>Aim and Objectives</h3> The aim of this work is to reassess the time of availability in this DCU and to identify the factors influencing this time. <h3>Material and Methods</h3> It is an ambispective monocentric study in which human factors (n=2), equipment factors (n=7), organisational factors (n=4), productivity factors (n=16) and time-related factors (n=6) were recorded randomly between September 2021 and April 2022 (i.e. 15 days studied). Data were also extracted from CHIMIO<sup>®</sup> software and from our institutional ‘LEAN tool’ for real-time monitoring of patients in oncologic DCU, in order to calculate time between the prescription of the day and the dispensation of the treatment. <h3>Results</h3> The average number of patients and preparations manufactured per day were respectively 105 (+/-7) and 146 (+/-12); 52% of these preparations prepared the day before. The average number of preparations not prescribed in advance is 49 [18-62] (34%) for an average number of 31 patients [14-43] (30%). The average time to availability was 54 min (+/- 16) with a median of 60 min. On average, 12 [0-24] patients per day waited more than an hour after the prescription with a maximum waiting time of 360 min. Four days (27%) were identified with an average dispensing time greater than 60 min. During these critical days, a percentage of anticipated preparations less than 50%, with a high number of prescriptions (&gt;30 patients) and particularly before 9:45 a.m. or between 12:00 and 14:00 p.m. were observed. We noticed also a higher productivity ([174-214] preparations), the lack of coordination (2 of 4 days), or additional productions (analgesic syringe preparations). <h3>Conclusion and Relevance</h3> Main impacting factors seem to be human factors and productivity. Time to availability became an essential quality indicator of our compounding anti-cancer unit. This study showed that our working procedures are efficient for a majority of patients, but not for all. <h3>References and/or Acknowledgements</h3> <h3>Conflict of Interest</h3> No conflict of interest 

/pdf/3pc-018-time-to-availability-of-injectable-anticancer-drugs-3v12vid3.pdf

3PC-018 Time to availability of injectable anticancer drugs for outpatients: reassessment in a French comprehensive cancer centre

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Osteonecrosis of the jaw under bisphosphonate and antiangiogenic therapies: cumulative toxicity profile?

3PC-018 Time to availability of injectable anticancer drugs for outpatients: reassessment in a French comprehensive cancer centre