A Case of Osteonecrosis of the Jaw Caused by Bevacizumab in a Colorectal Cancer Patient with Multiple Metastases

Abstract

We report a case of osteonecrosis of the jaw during chemotherapy using bevacizumab in a 69-year-old man with multiple metastases of colorectal cancer. The patient presented with persistent abdominal pain and constipation and was emergently admitted to our hospital. An abdominal CT scan and colonoscopy revealed severe stenosis caused by carcinoma in the cecum, so an ileus tube was placed for decompression. Further general investigations revealed multiple liver, lung and bone metastases. It was difficult to remove the primary lesion and Ileostomy was performed to relieve the obstruction. After the operation, the patient underwent chemotherapy with mFOLFOX6 + bevacizumab because he was positive for RAS mutation. After 11 cycles of the chemotherapy when 5 months had elapsed after the initiation, the patient complained of refractory stomatitis. Osteonecrosis of the jaw was noted by an oral surgeon. The bevacizumab therapy was therefore discontinued and the necrotic tissue was removed by surgical procedures. No recurrent necrosis has occurred after discontinuation of bevacizumab. Osteonecrosis of the jaw might be an adverse event of bevacizumab. There are few case reports on osteonecrosis due to bevacizumab in Japan. However, once osteonecrosis occurs, the present regimen must be reconsidered and it may also lower the patient's quality of life. Careful attention should be paid for patients undergoing chemotherapy including bevacizumab.