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Archives of Orthopaedic and Trauma Surgery

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01-10-2019 | Metastasis | Orthopaedic Surgery

Denosumab treatment for giant-cell tumor of bone: a systematic review of the literature

Authors: Gonzalo Luengo-Alonso, Maria Mellado-Romero, Shai Shemesh, Luis Ramos-Pascua, Juan Pretell-Mazzini

Published in: Archives of Orthopaedic and Trauma Surgery | Issue 10/2019

Abstract

Background

Denosumab is a human monoclonal antibody (mAb) that specifically inhibits tumor-associated bone lysis through the RANKL pathway and has been used as neoadjuvant therapy for giant-cell tumor of bone (GCTB) in surgical as well as non-surgical cases. The purpose of this systematic review of the literature, therefore, is to investigate: (1) demographic characteristics of patients affected by GCTBs treated with denosumab and the clinical impact, as well as, possible complications associated with its use (2) oncological outcomes in terms of local recurrence rate (LRR) and development of lung metastasis, and (3) characteristics of its treatment effect in terms of clinical, radiological, and histological response.

Methods

A systematic review of the literature was conducted using PubMed, EMBASE, and COCHRANE search including the following terms and Boolean operators: “Denosumab” AND “primary bone tumor”, “denosumab” AND “giant cell tumor”, “denosumab” AND “treatment”, and finally, “denosumab” AND “giant cell tumor” AND “treatment” since 2000. After applying inclusion and exclusion criteria, a total of 19 articles were included. The quality of the included studies was assessed using STROBE for the assessment of observational studies.

Results

A total of 1095 patients were included across all 19 studies. Across all the studies included, there were 615 females and 480 males. The mean patient age was 33.7 ± 8.3 years when starting the denosumab treatment. The pooled weighted local recurrence rate was 9% (95% CI 6–12%) and the pooled weighted metastases rate was 3% (95% CI 1–7%). The most common adverse event was fatigue and muscular pain. Radiologic response was estimated to occur in 66–100% of the patients. A significant reduction in pain under denosumab treatment was reported in seven studies and additional improvement in function and mobility was reported by several authors. Only two studies reported musculoskeletal tumor society (MSTS) scores which were better after denosumab treatment.

Conclusions

The use of denosumab as an adjuvant treatment of GCTB has shown a positive but variable histological response with consistent radiological changes and several types of adverse effects. There is a positive clinical response in terms of pain relief with decrease on the morbidity of surgical procedures to be performed. Finally, oncological outcomes are disparate with neither effect on metastatic disease nor local recurrence rates.

Level of evidence

IV.

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Title: Denosumab treatment for giant-cell tumor of bone: a systematic review of the literature
Authors: Gonzalo Luengo-Alonso
Maria Mellado-Romero
Shai Shemesh
Luis Ramos-Pascua
Juan Pretell-Mazzini
Publication date: 01-10-2019
Publisher: Springer Berlin Heidelberg
Keywords: Metastasis
Denosumab
Fatigue
Denosumab
Published in: Archives of Orthopaedic and Trauma Surgery / Issue 10/2019
Print ISSN: 0936-8051
Electronic ISSN: 1434-3916
DOI: https://doi.org/10.1007/s00402-019-03167-x

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Denosumab treatment for giant-cell tumor of bone: a systematic review of the literature

Abstract

Background

Methods

Results

Conclusions

Level of evidence

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Level of evidence

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