Clinical and pathologic results of denosumab treatment for giant cell tumors of bone:prospective study on 14 cases
Abstract
Objective: Giant cell tumor of bone(GCT) is primary osteolytic benign tumor bone. Surgery is commonly used treatment; however, recurrence remains problem. With discovery of Nuclear Factor kappa-B Receptor Activator (RANKL), responsible for the formation of osteoclastic cells, human monoclonal antibody-Denosumab used for treatment of GCT. The aim of this study was to evaluate clinical and pathologic results of denosumab in treatment of GCT, evaluate adverse effect profile and recurrence rate.
Methods: Fourteen lesions of 13 patients enrolled the study. The mean age was 38.3 years. Subcutaneous Denosumab (120 mg) was given every 4 weeks (with additional doses on days 8 and 15 in cycle 1 only) to patients. Patients were radiologically evaluated for response of the tumor. Pain and functional status were evaluated Visual Analog Score (VAS) and Musculoskeletal Tumor Society Score (MSTS). Adverse effects investigated after each cycle.
Results: There were 5 men and 8 women. Mean follow-up was 17 months. One lesion was Campanacci grade 1, 8 were grade 2, and 5 were grade 3. Eight of lesions were recurrent, and remaining primary lesions. After average 9 cycles (4-17 cycles), all tumors underwent radiologic regression. Ten lesions were removed surgically. More than 90% of giant cells were found to be pathologically regressed in all specimens. On the last follow-up,VAS was 1 and MSTS score was 87%. 46% of patients reported fatigue, joint and muscle pain after injections and mild hypocalcaemia seen in 1 patient.
Conclusion: Denosumab has been shown to be a successful drug in treatment of GCT. We recommend that denosumab should be used as neoadjuvant in patients in all recurrent lesions, grade 2 lesions with high surgical risk, grade 3 lesions and metastatic cases of GCT.
DOI: 10.3944/AOTT.2016.16.0013
This abstract belongs to the un-edited version of the article and is only for informative purposes. Published version may differ from the current version.