abstract

Denosumab as adjuvant therapy in giant cell tumor of bone: will surgery
become obsolete?
Abstract ID : 1498
Submitted by : Santos Sandra the 2016-02-22 22:54:31
Category : Targeted Therapy
Typology : Communication orale / Oral communication
Status : Validated
Authorisation to disclose : Yes/Oui
------------------------------------Introduction: Giant cell tumor (GCT) of bone is a common benign skeletal tumor, usually located in long bones but
occurring ocasionally in unusual locations, commonly extending near the articular surface. It is locally aggressive, and
the mainstay of treatment has been surgery, with either local curettage (associated with adjuvant techniques) or wider
resection of the lesion. However, curettage presents with a high recurrence rate, and resection of the tumor, due to its
proximity to articular surfaces, leads to considerable morbidity. Denosumab, a monoclonal antibody that targets the
osteoclastic activity of GCT, has been in use as a potential adjuvant therapy.
Material and Methods: We reviewed clinical data and outcomes regarding patients with histological diagnosis of GCT
treated with denosumab at our institution. Denosumab was administered at monthly intervals (120 mg subcutaneously),
with additional doses on days 8 and 15 during the first month of therapy only; all patients were prescribed calcium and
vitamin D supplementation. Disease status and clinical benefit were assessed based on monthly physical examination
and patient reporting, and periodic radiologic imaging assessment. Descriptive statistical analysis was performed.
Results: A total of 10 patients were identified, 6 female (60%) and 4 male (40%). The median age was 39 (25–81) years.
Only 4 patients presented with appendicular skeleton lesions; the remaining patients had GCT located to the spine and
pelvis. The majority (70%; n=7) of patients presented with primary GCT, and 30 % (n=3) had recurrent tumor following
previous curative intent procedures. Primary complain at presentation was pain, with only one patient presenting with a
pathological fracture. 70% of patients had a Campannaci classification III tumor, and all patients had a grade 3 Enneking
staging tumor. Patients were treated with denosumab for a median duration of 38 (19–72) months. Only one patient in
this group had surgery with curative intent, after 19 months of treatment, due to recurrent pain and functional limitation;
follow-up (569 days) showed no recurrence and good function. The remaining patients had significant pain relief and
functional improvement. In all cases, there was radiological evidence (serial radiographs and CT scans) of denosumab
efficacy, evidenced by arrest in bone lysis and increased cortical bone thickness and intralesional sclerosis. No
significant adverse reactions to denosumab were registered.
Discussion and Conclusion: Only one patient in our group underwent surgical treatment, with good results and no
recurrence to date. The remaining patients, most presenting with tumor locations in which surgery would lead to
significant morbidity, are presently symptom free, with no local disease progression. These results support the notion
that denosumab therapy may represent an important option for patients with resectable GCT, to control disease and
achieve equivalent outcomes with less morbid procedures or even no surgery, and in unresectable tumors, to allow for
disease control and symptomatic relief. Additional follow-up is needed to determine whether long-term denosumab
therapy alone is effective in disease control, and to assess possible complications and/or adverse effects associated
with prolonged treatment.
------------------------------------Keywords : Denosumab, Giant Cell Tumor, Treatment
Authors :
References : , , ,
Authors
Sandra Santos 1, Rúben Fonseca 1, Paulo Tavares 1, João Freitas 1, José Casanova 1,
1. Unidade de Tumores do Aparelho Locomotor, Centro Hospitalar e Universitário de Coimbra, Coimbra, PORTUGAL
Authors (raw format)
Santos Sandra - email : [email protected] Institution : Centro Hospitalar e Universitário de Coimbra
Department : Unidade de Tumores do Aparelho Locomotor City : Coimbra Country : PORTUGAL Speaker : Yes
Fonseca Rúben - email : [email protected] Institution : Centro Hospitalar e Universitário de Coimbra
Department : Unidade de Tumores do Aparelho Locomotor City : Coimbra Country : PORTUGAL Speaker : No
Tavares Paulo - email : [email protected] Institution : Centro Hospitalar e Universitário de Coimbra Department :
Unidade de Tumores do Aparelho Locomotor City : Coimbra Country : PORTUGAL Speaker : No
Freitas João - email : [email protected] Institution : Centro Hospitalar e Universitário de Coimbra
Department : Unidade de Tumores do Aparelho Locomotor City : Coimbra Country : PORTUGAL Speaker : No
Casanova José - email : [email protected] Institution : Centro Hospitalar e Universitário de Coimbra
Department : Unidade de Tumores do Aparelho Locomotor City : Coimbra Country : PORTUGAL Speaker : No