Anti-angiogenic drugs

Anti-angiogenic drugs target the processes by which new blood vessels are formed and are used in cancer treatment to restrict tumour vascularisation.

Not all anti-angiogenic drugs are currently implicated in MRONJ. However, MRONJ has been identified as a possible side effect of bevacizumabaflibercept and sunitinib by the MHRA. 

Anti-angiogenic drugs can be used in combination with the bisphosphonates in the management of cancer and there is some evidence that this results in a greater MRONJ risk. This may also be true where anti-angiogenic drugs are used in patients with a previous history of bisphosphonate use.

The use of anti-angiogenic drugs in cancer is an expanding field and it is likely that any future medications with these modes of action may also have an associated risk of MRONJ.