Safety evaluation of tooth extraction and establishment of predictive biomarkers for delayed healing in patients treated with antiangiogenic drugs

2022 Fiscal Year Final Research Report

• Project/Area Number: 19K19219
• Research Category: Grant-in-Aid for Early-Career Scientists
• Allocation Type: Multi-year Fund
• Review Section: Basic Section 57060:Surgical dentistry-related
• Research Institution: Hokkaido University (2022); Hokkaido Cancer Center(Department of Clinical Research) (2019-2021)
• Principal Investigator: Imamachi Kenji 北海道大学, 歯学研究院, 助教 (40779873)
• Project Period (FY): 2019-04-01 – 2023-03-31
• Keywords: 血管新生阻害薬 / 抜歯 / 創傷治癒遅延 / 薬剤関連顎骨壊死

Outline of Final Research Achievements

We investigated tooth extraction in cancer patients receiving bevacizumab (BV). There was no significant difference in post-extraction adverse events between tooth extraction with BV continuation and tooth extraction with BV suspension. In the study of risk factors, concomitant use of taxane anticancer drugs significantly increased risk. The risk was also significantly increased in mandibular molars and surgical tooth extraction with bone removal. In addition, while accumulating cases, we found 3 cases of spontaneous osteonecrosis of the jaw (drug-related osteonecrosis of the jaw: MRONJ) without tooth extraction during administration of BV. In none of the cases was concomitant use of bone-modifying drugs, and the site of occurrence was the mandibular molar region, the maxillary molar region, and the palate prominence, respectively. Concomitant use of taxane anticancer drugs was reported in 2 of the 3 cases.

Free Research Field

歯科口腔外科

Academic Significance and Societal Importance of the Research Achievements

これまで、血管新生阻害薬投与中の患者において、抜歯が必要になった際に休薬期間はどの程度必要なのか、そもそも休薬自体必要なのかなど不明な点が多いのが現状であった。血管新生阻害薬の休薬はがん治療そのものへのデメリットとなりうるため、徒に全ての抜歯症例で休薬するのではなく、症例によって抜歯前の不要な休薬が回避しうることが判明したのは社会的意義が大きいものと考えられる。本研究の成果は、がん患者に対する安全な歯科医療の提供に寄与することが期待される。