Indication-specific use of Denosumab in Giant Cell Tumour of Bone: A retrospective cohort study
Mylene Jc Duivenvoorden1, Vineet Kurisunkal2, Gerjon Hannink3
1Royal Orthopaedic Hospital, Oncology Department, Birmingham, United Kingdom; Amsterdam UMC, University of Amsterdam, Department of Orthopaedic Surgery, Amsterdam Movement Sciences, Cancer Center Amsterdam, Amsterdam, the Netherlands.
Introduction:
Giant Cell Tumours of Bone (GCTB) are locally aggressive, benign bone tumours. Denosumab was initially introduced as a neoadjuvant therapy to facilitate curettage but is now also used prior to en-bloc resection, as definitive treatment for unresectable disease, and as long-term treatment for recurrent or metastatic disease. Evidence regarding indication-specific outcomes remains limited. This study evaluated contemporary Denosumab use according to treatment intent, focusing on treatment duration, recurrence patterns, and long-term administration.
Materials And Methods:
A retrospective review was conducted of all GCTB patients treated with Denosumab at the Royal Orthopaedic Hospital, Birmingham, between 2010 and 2023. Patients were categorized according to treatment intent: 1) Short-course Neoadjuvant Denosumab (SCND), 2) Long-course Neoadjuvant Denosumab (LCND), 3) Definitive Denosumab for unresectable disease, and 4) Long-term Denosumab following local or distant recurrence.
Results:
The study included 155 patients. Twenty-eight patients (18%) received SCND for median 15 weeks (IQR 11-20), local recurrence occurring in 13 patients (46%). Fifty-two patients (34%) received LCND for median 22 weeks (IQR 13-54), local recurrence occurring in 6 patients (12%). Forty-two patients (27%) received definitive Denosumab for median 123 weeks (IQR 83-182), while 33 patients (21%) received long-term Denosumab following recurrence for median 123 weeks (IQR 29-247). Dose de-escalation was frequently feasible in patients with sustained disease control, whereas adverse events were primarily associated with prolonged treatment exposure.
Conclusion:
This study demonstrates that Denosumab is used across several distinct clinical indications in GCTB. High recurrence rates were observed following short-course neoadjuvant treatment prior to curettage, whereas prolonged disease control was frequently achieved in selected patients receiving definitive or long-term Denosumab. A preliminary clinical framework for indication-specific Denosumab use is proposed and warrants prospective validation.
