TKI MRONJ — SCE Medical Oncology MCQ

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ModerateImmunotherapy & Targeted TherapyTKI MRONJSCE Medical Oncology

A 72-year-old man on cabozantinib for RCC develops a non-healing wound 6 weeks after a dental extraction. The dentist notes exposed bone in the mandible. What is the most likely diagnosis?

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Correct answer: E — Medication-related osteonecrosis of the jaw (MRONJ) from cabozantinib (an anti-VEGF TKI)

MRONJ is not limited to bisphosphonates and denosumab — anti-angiogenic agents (bevacizumab, VEGFR-TKIs including sunitinib, cabozantinib, pazopanib, lenvatinib) can also cause MRONJ through impaired bone vascularity and healing. Risk factors include: dental extractions during treatment, poor oral hygiene, and concurrent corticosteroids. Prevention requires dental assessment before starting anti-VEGF therapy and avoidance of invasive dental procedures during treatment. Management is conservative (antibiotics, antiseptic rinses, avoiding further trauma).

Reference: BNF Cabozantinib; AAOMS MRONJ Position Paper 2022; ESMO Supportive Care