Cure Alveolar Soft Part Sarcoma International (iCureASPS)

Abstract

BACKGROUND AND PURPOSE

Bisphosphonate-related osteonecrosis of the jaw (BRONJ) has been identified as a severe complication of patients previously treated with i.v. bisphosphonates. It has been noted that necrotic bone from BRONJ sites display signs of bacterial infection suggesting that an immune defect may play a role in the pathophysiology of BRONJ. Here, we have examined the effect of two potent bisphosphonates, zoledronate and pamidronate, on neutrophil function, differentiation and survival.



https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3268204/

Pathophysiology of BRONJ: Drug-related osteoclastic disease of the jaw



Abstract
Since the first article about bisphosphonate-related osteonecrosis of the jaw (BRONJ) was published in 2003, clinical and basic research for BRONJ has continued worldwide to understand this novel disease. Several organizations have proposed the definition, diagnostic criteria, risk factors, and treatment strategy for BRONJ. Recently, some new drugs used for cancer patients such as bevacizumab and sunitinib have also been reported to be involved in osteonecrosis of the jaw (ONJ). Because ONJ appears to be initially derived from osteoclast inhibition, a new category of diseases named as “drug-related osteoclastic disease of the jaw” may be assumed. Considering the accumulated knowledge related to BRONJ, including osteoclast biology, bisphosphonate pharmacology, animal experiments, and clinicopathological findings, a perspective of BRONJ from the pathophysiological viewpoint is proposed in this review.

https://www.researchgate.net/publicatio ... of_the_jaw

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We’ve come along ways since 2015 to current , from targeted TKIS to immune therapies .
So us
However an inordinate amount of our folks succumbed after upper tumor mets from lower bone issues . So with the usage of TKIs , there needs to be a scrutiny ,a personal (personalized) evaluation to when and where to introduce these possible immune suppression type meds .?
It is a question , as I’m not a doctor .

Bump

Even if there is a neutrophils suppression by the bisphosphonates, it might be not such a bad thing, as long as there is no lymphocytes suppression. Although the bacterial infections is a real danger in advanced cancer patients, when the neutrophils are to high, it is a bad thing as well. They are the vehicles of immune system evasion by the cancers/sarcomas (just do not ask me how, it is beyond my grasp) and as we know, a higher neutrophil-to-lymphocyte ratio (NLR) is associated with poorer survival outcomes. So it is hard to say what is the risk/benefits ration here