Giant-cell tumor of bone: treatment options and role of denosumab

Figures & data

Figure 1 Pathophysiology of giant-cell tumor of bone.

Abbreviation: RANKL, receptor activator of nuclear factor-κB ligand; SDF-1, Stromal cell-derived factor 1; MCP-1, Monocyte Chemoattractant Protein-1; OPG, osteoprotegrin; TRAP, tartrate resistant acid phosphatase; RANK, receptor activator of NF-kappaB.

Table 1 Systemic therapies for giant-cell tumor of bone (GCTB)

Therapy	Type of study	Patients, n	Outcome
Sunitinib^Citation28	Phase II	1	68+ weeks on study SD
Bisphosphonates^Citation21	Retrospective	25	Confounded by use of CT, XRT, IFNα, Emb In vitro inhibition of GCTB-derived osteoclast resorption
Bisphosphonates^Citation29	Retrospective, case-controlled, after curettage	44	One of 24 developed recurrence in the bisphosphonate group; six of 20 in the control group
Zoledronic acid^Citation30	Phase II, after intralesional curettage	24	82% RFS at 60 months with zoledronic acid
Calcitonin	Retrospective, calcitonin after curettage	25	52% had local recurrences
Denosumab^Citation23,Citation26,Citation31	Phase I	37	20 of 20 patients with histologic response
			Ten of 15 with radiologic response
			Five of 27 had grade 3–5 AEs
	Phase II	282	163 of 169 had no disease progression in cohort 1 (not a surgical candidate)
			72% had objective tumor response
			Three patients with ONJ
			9% SAEs reported
	Phase II	271	Most patients had improvement in pain within 2 months

Abbreviations: SD, stable disease; CT, computed tomography; XRT, radiation therapy; IFN, interferon; Emb, embolization; RFS, recurrence-free survival; AEs, adverse events; ONJ, osteonecrosis of the jaw; SAEs, serious AEs.

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