Current indications for denosumab in benign bone tumours

Area of Science:

• Oncology
• Orthopedics
• Pharmacology

Background:

• Denosumab is a monoclonal antibody targeting the RANK-RANKL pathway.
• It induces apoptosis in osteoclast-like giant cells, impacting bone remodeling.
• Denosumab is a standard treatment for unresectable or metastatic giant cell tumor of bone (GCTB).

Purpose of the Study:

• To evaluate the efficacy and safety of denosumab in GCTB treatment.
• To explore the potential of denosumab in neoadjuvant settings and joint-saving surgeries.
• To investigate the long-term treatment strategies and adverse events associated with denosumab therapy for GCTB.
• To examine the off-label use of denosumab in other giant cell-rich lesions.

Main Methods:

• Review of current literature and clinical data on denosumab for GCTB.
• Analysis of in vitro studies investigating combination therapies.
• Assessment of case reports and series on off-label denosumab use.

Main Results:

• Denosumab demonstrates high efficacy in GCTB, enabling tumor resection and preventing morbid surgery.
• Neoadjuvant denosumab may facilitate surgery but requires caution due to recurrence risks.
• Long-term denosumab therapy for unresectable/metastatic GCTB raises questions about treatment frequency and adverse events.
• Promising preliminary results exist for off-label denosumab use in aneurysmal bone cysts and central giant cell granulomas.

Conclusions:

• Denosumab is a valuable therapeutic option for GCTB, but long-term management requires further investigation.
• Combination therapies and off-label applications show potential but need validation through large prospective trials.
• Prospective clinical trials are essential to determine the optimal role and safety profile of denosumab in rare giant cell lesions.