Denosumab administration for bone metastases from solid tumors: a retrospective cross-sectional study
Kohei Mizuta1, Hiromichi Oshiro1, Ryo Katsuki1
1Department of Orthopedic Surgery, Graduate School of Medicine, University of the Ryukyus, 207 Uehara, Nishihara, Okinawa, 903-0215, Okinawa, Japan.
Background:
Little is known on how denosumab reduces skeletal-related events (SREs) by bone metastases from solid tumors. We sought to evaluate the effect of denosumab administration in patients with bone metastases from solid tumors.
Methods:
Data of patients treated with denosumab were collected from electronic medical charts (n = 496). Eligible participants in this study were adult patients (age ≥ 18 years) with metastatic bone lesions from solid tumors treated with denosumab. SREs, surgical interventions, the spinal instability neoplastic score (SINS) for spinal region, and Mirels' score for the appendicular region were evaluated. To assess whether denosumab could prevent SREs and associated surgery, the SINS and Mirels' score were compared between patients with and without SREs.
Results:
A total of 247 patients (median age, 65.5 years old; median follow-up period, 13 months) treated with denosumab for metastatic bone lesions from solid tumors were enrolled in this study. SREs occurred in 19 patients (7.7%). SREs occurred in 2 patients (0.8%) who took denosumab administration before SREs. Surgical interventions were undertaken in 14 patients (5.7%) (spinal and intradural lesions in five patients and appendicular lesions in nine patients). The mean SINS of patients without SREs compared to those with SREs were 7.5 points and 10.2 points, respectively. The mean Mirels' scores of non-SREs patients and those with SREs were 8.07 points and 10.7 points, respectively. Patients with SREs had significantly higher Mirels' score than non-SREs patients (p < 0.01). Patients with SREs had higher SINS than non-SREs patients (p = 0.09).
Conclusions:
SREs occurred in patients with higher SINS or Mirels' scores. Two patients suffered from SREs though they took denosumab administration before SREs. Appropriate management of denosumab for patients with bone metastasis is significant. Surgical interventions may be needed for patients who with higher SINS or Mirel's scores.
Insights
Denosumab may help prevent skeletal-related events (SREs) in patients with bone metastases. Higher SINS or Mirels' scores indicate increased SRE risk, even with denosumab treatment.
Area of Science:
- Oncology
- Orthopedics
- Pharmacology
Background:
- Limited understanding of denosumab's mechanism in reducing skeletal-related events (SREs) in solid tumor bone metastases.
- Need to evaluate denosumab's efficacy in preventing SREs and associated surgeries.
Purpose of the Study:
- To assess the effect of denosumab on SREs in patients with bone metastases from solid tumors.
- To compare SINS and Mirels' scores in patients with and without SREs to understand risk factors.
Main Methods:
- Retrospective analysis of 247 adult patients with metastatic bone lesions treated with denosumab.
- Evaluation of SREs, surgical interventions, Spinal Instability Neoplastic Score (SINS), and Mirels' score.
- Comparison of SINS and Mirels' scores between patients with and without SREs.
Main Results:
- SREs occurred in 7.7% of patients; 2 patients experienced SREs despite prior denosumab administration.
- Patients with SREs had significantly higher Mirels' scores (p<0.01) and higher SINS (p=0.09) compared to those without.
- Surgical interventions were performed in 5.7% of patients for spinal, intradural, or appendicular lesions.
Conclusions:
- Elevated SINS or Mirels' scores are associated with SRE occurrence in patients with bone metastases.
- Denosumab management requires careful consideration, as SREs can occur even with treatment.
- Surgical intervention may be necessary for patients presenting with high SINS or Mirels' scores.
