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Oral Complications of Chemotherapy and Head/Neck Radiation (PDQ®)

  • Updated: 04/23/2014

Table 5. Drugs and Biologics Used in Oncology and Reported to Be Associated With ONJ

Drug Generic (Trade Name) Manufacturer (Indication) Class of Drug Mode of Action Reported to Cause ONJ? 
GIST = gastrointestinal stromal tumor; ONJ = osteonecrosis of the jaw associated with medications; RANKL = receptor activator of nuclear factor kappa beta ligand; VEGF = vascular endothelial growth factor.
Zoledronic acid (Zometa, Reclast)Novartis (bone metastasis; bone loss from cancer therapy)Bisphosphonate (antiresorptive)Inhibition of osteoclastsYes
Pamidronate (Aredia)NovartisBisphosphonate (antiresorptive)Inhibition of osteoclastsYes
Alendronate (Fosamax)Merck (bone loss from cancer therapy)Bisphosphonate (antiresorptive)Inhibition of osteoclastsYes
Denosumab (Prolia, XGeva)Amgen, Inc. (bone metastasis; osteoporosis; bone loss from cancer therapy)Humanized monoclonal antibody (antiresorptive)Suppression of bone remodeling by inhibition of RANKLYes
Bevacizumab (Avastin)Genentech BioOncology (advanced cancers: metastatic colorectal cancer; nonsquamous non-small cell lung cancer; metastatic breast cancer; glioblastoma; metastatic renal cell carcinoma)AntiangiogenicInhibition of angiogenesis by blocking the action of VEGFYes
Sunitinib (Sutent)Pfizer Oncology (advanced renal cell carcinoma; GIST)AntiangiogenicInhibition of angiogenesis by blocking VEGF tyrosine kinaseYes
Sorafenib (Nexavar)Bayer Health Care Pharmaceuticals (renal cell carcinoma; hepatocellular carcinoma)AntiangiogenicInhibition of angiogenesis by blocking VEGF tyrosine kinaseYes, when combined with antiresorptives