Multiple Pulmonary Metastases of Recurrent Giant Cell Tumor of Bone with Expression of VEGFR-2 Successfully Controlled by Denosumab and Apatinib: A Case Report and Literature Review

Abstract

Giant cell tumor of bone (GCTB) is a rare, benign, but locally aggressive bone tumor. It has a high tendency for local recurrence, which may increase the incidence of lung metastasis. Currently, an optimal treatment strategy has not been established because of the rarity of pulmonary metastatic GCTB. Denosumab is the preferred regimen for unresectable metastatic lesions; however, there are no alternative treatment options when patients are resistant to denosumab. Apatinib is a small-molecule tyrosine kinase inhibitor that selectively competes for the vascular endothelial growth factor receptor 2 (VEGFR-2) ATP binding site, and several studies have analyzed the effectiveness of apatinib in advanced or metastatic tumors. However, there is no report of apatinib as an anti-angiogenesis therapy for pulmonary metastatic GCTB to date. Here, we present a case of a 26-year-old female who was diagnosed with recurrent and pulmonary metastatic GCTB. Immunohistochemical (IHC) staining indicated that the tumor cells were positive for VEGFR-2. Denosumab was administered to control the metastases; nevertheless, disease progression was confirmed after four months of treatment. Given the IHC results and rapid disease progression, apatinib was added to the treatment strategy. After 42 months of treatment, the patient showed noticeable symptomatic improvement and considerable tumor shrinkage.

Keywords:

• giant cell tumor of bone
• pulmonary metastasis
• VEGFR-2
• denosumab
• apatinib

Acknowledgments

We thank for the support of Professor Xianliang Zhang, Dr. Yahan Zhang, Department of Pathology, West China Hospital.

Abbreviations

GCTB, giant cell tumor of bone; CT, computed tomography; IHC, immunohistochemical; PR, Partial response; VEGF, vascular endothelial growth factor; VEGFR-2, vascular endothelial growth factor receptor 2; TKI, tyrosine kinase inhibitor; SPECT, single-photon emission computed tomography; RANKL, nuclear factor κB ligand.

Data Sharing Statement

All data used or analyzed during this study are included in this published article.

Ethics Statement

This study was approved by the institutional Ethics Committee of West China Hospital, Sichuan University. Institutional approval was required for the publication of the case details. The patient provided written, informed consent for the publication of the case details.

Disclosure

The authors declare that they have no competing interests.