Cancer treatment and research communications · 2026
Temporal changes in Denosumab use among patients with giant cell tumour of bone at a specialist oncology centre: a retrospective cohort study.
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Duivenvoorden Mylene J C, Kurisunkal Vineet, Hannink Gerjon, Parry Michael, Jeys Lee, Verspoor Floortje G M
Аннотация
OBJECTIVES: Denosumab, a RANKL inhibitor, has transformed the management of giant cell tumor of bone (GCTB). This study evaluates evolving patterns of Denosumab therapy, associated outcomes, and adverse events in a large cohort.
DESIGN: A retrospective review was conducted on all GCTB patients who were treated at the Royal Orthopaedic Hospital, Birmingham, UK, between 2000 and 2023. Patients who received Denosumab as part of their management were included. Data was stratified by tumour location (axial skeleton vs. extremities) and treatment period (before or after 2018).
RESULTS: Among 155 eligible patients (median age 34 years, IQR 25-47; 52% female), Denosumab treatment patterns changed markedly over time. Prior to 2018, short-course neoadjuvant Denosumab before intralesional curettage was common but was associated with high local recurrence rates (37% in extremities, 10% in axial skeleton). After 2018, Denosumab was used more selectively for long-term disease control, especially in complex or inoperable cases. Adverse events occurred in 18% of patients, and were categorized as serious (14/155, 9%), moderate (7/155, 5%), or mild (7/155, 5%). Respectively they occurred after median 45 weeks (IQR 8-100), 45 weeks (IQR 22-94) and 130 weeks (IQR 89-220). The adverse events occurred more frequently on a monthly Denosumab regime(16%, 25/155) when compared to 2-monthly(3%, 2/59) and 3-monthly (3%, 1/31).
CONCLUSIONS: These findings reveal a change in Denosumab use for GCTB, moving away from short-course neoadjuvant therapy due to high recurrence risk, and towards long-term treatment in select patients. A standardized Denosumab dosing regimen is recommended to achieve consistent international treatment outcomes, safely reduce dosage, and potentially lower the risk of adverse events. Our results support a tailored, multidisciplinary approach with careful monitoring for adverse events and ongoing research studies to refine treatment protocols.
DESIGN: A retrospective review was conducted on all GCTB patients who were treated at the Royal Orthopaedic Hospital, Birmingham, UK, between 2000 and 2023. Patients who received Denosumab as part of their management were included. Data was stratified by tumour location (axial skeleton vs. extremities) and treatment period (before or after 2018).
RESULTS: Among 155 eligible patients (median age 34 years, IQR 25-47; 52% female), Denosumab treatment patterns changed markedly over time. Prior to 2018, short-course neoadjuvant Denosumab before intralesional curettage was common but was associated with high local recurrence rates (37% in extremities, 10% in axial skeleton). After 2018, Denosumab was used more selectively for long-term disease control, especially in complex or inoperable cases. Adverse events occurred in 18% of patients, and were categorized as serious (14/155, 9%), moderate (7/155, 5%), or mild (7/155, 5%). Respectively they occurred after median 45 weeks (IQR 8-100), 45 weeks (IQR 22-94) and 130 weeks (IQR 89-220). The adverse events occurred more frequently on a monthly Denosumab regime(16%, 25/155) when compared to 2-monthly(3%, 2/59) and 3-monthly (3%, 1/31).
CONCLUSIONS: These findings reveal a change in Denosumab use for GCTB, moving away from short-course neoadjuvant therapy due to high recurrence risk, and towards long-term treatment in select patients. A standardized Denosumab dosing regimen is recommended to achieve consistent international treatment outcomes, safely reduce dosage, and potentially lower the risk of adverse events. Our results support a tailored, multidisciplinary approach with careful monitoring for adverse events and ongoing research studies to refine treatment protocols.