Osteonecrosis of the jaw induced by treatment with anti-PD-1 immunotherapy: a case report

Xerxes Pundole, Amy Little Jones, Michael T. Tetzlaff, Michelle D. Williams, William A. Murphy, Adegbenga Otun, Ryan P. Goepfert, Michael A. Davies

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)1213-1219
Number of pages7
Issue number17
StatePublished - Dec 2020


  • anti-PD-1
  • checkpoint inhibitors
  • fracture
  • immunotherapy
  • melanoma
  • nivolumab
  • osteonecrosis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology
  • Oncology


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