Pre-operative denosumab is associated with higher risk of local recurrence in giant cell tumor of bone: a systematic review and meta-analysis

Chen, Xi; Li, Hairui; Zhu, Shibai; Wang, Yiou; Qian, Wenwei

doi:10.21203/rs.2.21735/v2

Cited by 3 publications

(3 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Denosumab has helped in facilitating curettage in lesions with extensive bone loss and/or a cortical break with a large soft tissue component. The benefit of using preoperative denosumab to facilitate curettage is tempered by concern regarding the increased rate of local recurrence after denosumab treatment (Chen et al, 2020;Perrin et al, 2021). The study of Mak et al (2014) showed that cell proliferation is only diminished by denosumab; the cells continue to proliferate in vitro, though at a slower rate.…”

Section: Discussionmentioning

confidence: 99%

Giant cell tumour of hand bones: outcomes of treatment

Puri

Rajalbandi

Gulia

2021

J Hand Surg Eur Vol

View full text Add to dashboard Cite

The purpose of this study was to report the incidence of giant cell tumour of the hand bones in an Asian population, document treatment options and report outcomes of treatment. Of 698 giant cell tumours of bone that underwent surgery between January 2011 and December 2020 at our institute, only 22 (3%) were in the hand. Fourteen occurred in the metacarpals, eight in the phalanges. Fifteen were primary tumours and seven had recurrent disease. Twenty lesions had an associated soft tissue component. Two patients treated for primary disease and one who had been treated for recurrence had local recurrence. Recurrence occurred in two of nine patients treated with curettage, one of three with resection and none of five with ray or digit amputation. Both curettage and resection/amputation are acceptable treatment options for the rare condition of giant cell tumour of bone in the hand, with a need to individualize treatment decisions based on the site and extent of disease to minimize treatment morbidity while maximizing disease control. Level of evidence: IV

show abstract

Section: Discussionmentioning

confidence: 99%

Giant cell tumour of hand bones: outcomes of treatment

Puri

Rajalbandi

Gulia

2021

J Hand Surg Eur Vol

View full text Add to dashboard Cite

show abstract

“…Many of last year's published papers on GCTB treatment express concerns on an increased recurrence risk after denosumab but must be interpreted with the following concerns in mind. Three systematic reviews and meta-analyses were published, with an overlap of seven of the included studies [35][36][37]. In the majority of these studies, no matching was performed for tumor size, extension, or Campanacci grade and conclusions are subject to indication bias.…”

Section: Local Recurrence After Denosumabmentioning

confidence: 99%

Updated concepts in treatment of giant cell tumor of bone

Heijden¹,

Lipplaa²,

Langevelde³

et al. 2022

Current Opinion in Oncology

View full text Add to dashboard Cite

Purpose of reviewGiant cell tumors of bone (GCTB) are intermediate, locally aggressive primary bone tumors. For conventional GCTB, surgery remains treatment of choice. For advanced GCTB, a more important role came into play for systemic therapy including denosumab and bisphosphonates over the last decade.Recent findingsIn diagnostics, focus has been on H3F3A (G34) driver mutations present in GCTB. The most frequent mutation (G34W) can be detected using immunohistochemistry and is highly specific in differentiating GCTB from other giant cell containing tumors. PD-L1 expression can be used as biological marker to predict higher recurrence risks in GCTB patients.The use of bisphosphonate-loaded bone cement is under investigation in a randomized controlled trial. A new technique consisting of percutaneous microwave ablation and bisphosphonate-loaded polymethylmethacrylate cementoplasty was proposed for unresectable (pelvic) GCTB.Increased experience with use of denosumab raised concern on elevated recurrence rates. However, conclusions of meta-analyses should be interpreted with risk of indication bias in mind. Several small studies are published with short-course denosumab (varying from 3 to 6 doses). One small trial directly compared denosumab and zoledronic acid, with no statistical differences in radiological and clinical outcome, and nonsignificantly higher recurrence rate after denosumab. As bisphosphonates directly target neoplastic stromal cells in GCTB, larger directly comparative trials are still warranted.SummaryNeoadjuvant denosumab is highly effective for advanced GCTB, and a short-course is advised to facilitate surgery, whereas increased recurrence rates remain of concern. Randomized controlled trials are conducted on bisphosphonate-loaded bone cement and on optimal dose and duration of neoadjuvant denosumab. PD-L1 could be a potential new therapy target in GCTB.

show abstract

“…The authors believed denosumab may be associated with an increase in local recurrence although the evidence was weak due to lack of randomized studies and indication bias. In another meta-analysis covering 10 studies with 1,082 cases, Chen et al ( 46 ) found that denosumab therapy was correlated with higher local recurrence rate and inferior 5-year recurrence-free survival.…”

Section: Denosumab May Increase the Risk Of Local Recurrence In Patiementioning

confidence: 99%

Denosumab in Giant Cell Tumor of Bone: Current Status and Pitfalls

Gao

et al. 2020

Front. Oncol.

View full text Add to dashboard Cite

Denosumab is a monoclonal antibody against RANK ligand for treatment of giant cell tumor of bone (GCTB). Clinical trials and case series have demonstrated that denosumab is relevant to beneficial tumor response and surgical down-staging in patients of GCTB. However, these trials or case series have limitations with a short follow-up. Recent increasing studies revealed that denosumab probably increased the local recurrence risk in patients treated with curettage. This may be caused by the thicken bone margin of tumor that trapped tumor cells from curettage. The direct bone formation by tumor cells in the margin after denosumab treatment also contributed to the local recurrence. in vitro studies showed denosumab resulted in a cytostatic instead of a true cytotoxic response on neoplastic stromal cells. More importantly, denosumab-treated GCTB exhibited morphologic overlap with malignancy, and a growing number of patients of malignant transformation of GCTB during denosumab treatment have been reported. The optimal duration, long term safety, maintenance dose, and optimum indications remain to be elucidated. With these concerns in mind, this review warns that the denosumab therapy of GCTB should be applied with caution.

show abstract

Pre-operative denosumab is associated with higher risk of local recurrence in giant cell tumor of bone: a systematic review and meta-analysis

Cited by 3 publications

References 19 publications

Giant cell tumour of hand bones: outcomes of treatment

Giant cell tumour of hand bones: outcomes of treatment

Updated concepts in treatment of giant cell tumor of bone

Denosumab in Giant Cell Tumor of Bone: Current Status and Pitfalls

Contact Info

Product

Resources

About