Journal
IMMUNOTHERAPY
Volume 12, Issue 17, Pages 1213-1219Publisher
FUTURE MEDICINE LTD
DOI: 10.2217/imt-2020-0108
Keywords
anti-PD-1; checkpoint inhibitors; fracture; immunotherapy; melanoma; nivolumab; osteonecrosis
Categories
Funding
- Roche/Genentech
- GSK
- Astrazeneca
- Sanofi-Aventis
- Merck
- Myriad
- Oncothyreon
- NIH/NCI [2T32CA009666-25]
- Dr Miriam and Sheldon G Adelson Medical Research Foundation
- AIM at Melanoma Foundation
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Recognizing rare but clinically significant toxicity of immunotherapy is critical. Here we describe the first detailed case of severe osteonecrosis of the jaw due to anti-PD-1. A 75-year-old man with metastatic melanoma, with no prior radiation or treatment with bone-targeting agents, experienced jaw pain 1 week after his first dose of nivolumab. Imaging studies were negative, and treatment was resumed after pain was controlled. 4 months later, the patient experienced acute exacerbation of pain and malocclusion of the jaw. Imaging showed bilateral fractures of the angle of mandible with extensive disruption of the normal trabecular architecture, requiring total mandibulectomy. The patient's metastatic melanoma responded to treatment and remains controlled >20 months after treatment cessation without further therapy.
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