Osteonecrosis of the Jaw during Lenvatinib Therapy: A Case Report Based on Surgical Management

Lenvatinib is a molecular targeted drug used in the treatment of patients with unresectable thyroid cancer. We present a case of medication-related osteonecrosis of the jaw (MRONJ), which occurred in a patient receiving lenvatinib therapy and which was treated by surgical management. The objectives of this paper are to highlight the possibility of MRONJ being associated with lenvatinib and to accumulate knowledge regarding the management and treatment of MRONJ associated with antiangiogenic drugs. The patient's past medical history included thyroid follicular carcinoma with multiple bone metastasis diagnosed in 2013. Lenvatinib was used on the patient in July 2015 for the treatment of thyroid follicular carcinoma. Three months after the start of the lenvatinib drug holiday, a sequestrectomy involving the extraction of the lower right canine and upper left first premolar was performed under general anesthesia. The patient maintained lenvatinib therapy and when a follow-up was made five months after sequestrectomy, the wound showed complete mucosal healing. Levatinib is related to MRONJ and its developmental mechanism might be caused by inhibition of angiogenesis targeting vascular endothelial growth factor receptor.