USE OF DENOSUMAB IN GIANT-CELL TUMOR AT A PUBLIC HOSPITAL IN SOUTHERN BRAZIL: REPORT OF 13 CASES

ABSTRACT

Giant-cell tumor is a relatively rare neoplasia, benign but locally aggressive, that causes significant bone destruction with predilection for epiphyseal and metaphyseal regions of long bones and the spine. Definitive treatment is surgical, with complete tumoral resection followed by autograft, homograft, arthrodesis, unconventional endoprostheses or methylmethacrylate. In most cases, surgery is accompanied by high morbidity and variable recurrence rates, depending on the site, size and type of surgical intervention.Denosumab, a RANKL inhibitor, acts by decreasing tumoral osteoclastic activity and is approved by the Food and Drug Administration for treatment of GCT when surgery is not possible or when it is associated with high morbidity. This report of cases is based on the review of medical records from the Ambulatory Service for Adolescents and Young Adults (AYA), aiming to show the experience of the Service with the use of denosumab for neoadjuvant purposes.

RESUMO

O tumor de células gigantes é uma neoplasia relativamente rara, benigna, mas localmente agressiva, que causa destruição óssea significativa, com predileção por regiões epifisárias e metafisárias de ossos longos e da coluna vertebral. O tratamento definitivo é cirúrgico, com ressecção tumoral completa seguida de autoenxerto, homoenxerto, artrodese, endoprótese não convencional ou metilmetacrilato. Na maioria dos casos, a cirurgia é acompanhada por alta morbidade e taxas variáveis de recorrência, dependendo do local, tamanho e tipo de intervenção cirúrgica. O denosumabe, um inibidor da RANKL, atua diminuindo a atividade osteoclástica tumoral e é aprovado pela Food and Drug Administration para o tratamento do TGC quando a cirurgia não é possível ou quando está associada a alta morbidade. Este relato de casos baseia-se na revisão de prontuários do Serviço Ambulatorial de Adolescentes e Jovens Adultos (AJA), com o objetivo de mostrar a experiência do Serviço com o uso de denosumabe para fins neoadjuvantes.

Keywords:

Denosumab - RANK Ligand - Giant Cell Tumors.

Descritores:

Denosumab - Ligando RANK - Tumores de Células Gigantes.

AUTHOR'S CONTRIBUTION

Tamise da Silva Baptista: Collection and assembly of data, Conception and design, Data analysis and interpretation, Final approval of manuscript, Manuscript writing, Provision of study materials or patient.

Rita Ferrua: Collection and assembly of data, Conception and design, Data analysis and interpretation, Final approval of manuscript, Manuscript writing, Provision of study materials or patient.

Lucilda Cerqueira Lima: Collection and assembly of data, Conception and design, Data analysis and interpretation, Final approval of manuscript, Manuscript writing, Provision of study materials or patient.

Aline Rocha Lino: Collection and assembly of data, Data analysis and interpretation, Manuscript writing.

Gerson Gandhi Ganev: Conception and design, Final approval of manuscript, Provision of study materials or patient.

Paulo Kechele: Conception and design, Final approval of manuscript, Provision of study materials or patient.

Publication History

Received: 27 September 2018

Accepted: 11 April 2019

Article published online:
09 May 2019

• REFERENCES

• Agarwal A, Larsen BT, Buadu LD, Dunn J, Crawfor R, Daniel J. et al Denosumab Chemotherapy for recurrent giant-cell tumor of bone: a case report of neoadjuvant use enabling complete surgical resection. Case Reports in Oncological Medicine 2013; 2013: 1-4
• Schwartz HS.. Giant Cell Tumor of bone. Comprehensive Therapy 1993; 19 (02) 64-68
• Mendenhall WM, Zlotecki RA, Scarborough MT, Gibbs CP, Mendenhall NP.. Giant- cell tumor of bone. American Journal Clinical Oncology 2006; 29 (06) 96-99
• Dufresne A, Derbel O, Cassier P, Vaz G, Decouvelaere A, Blay J.. Giant-cell tumor of boné, anti-RANKL therapy. Bonekey Reports 2012; 1 (149) 1-8
• Karras NA, Polgreen LE, Ogilvie C, Manivel JA, Skubitz KM, Lipsitz E.. Denosumab treatment of metastatic giant-cell tumor of bone in a 10-yearold girl. Journal of Clinical Oncology 2013; 31 (13) 200-202
• XU SF, Adams B, Yu XC, Xu M.. Denosumab and giant cell tumor of bone - a review and future management considerations. Current Oncology 2013; 20 (05) 442-447
• Chakarun CJ, Foster DM, Gottsegen CJ, Patel DB, White EA, Matcuk GR.. Giant cell tumor of bone: review, mimics, and new developments in treatment. Radiographics 2013; 33 (01) 197-211
• DeVita VT, Lawrence TS, Rosenberg SA.. Cancer Principles and Practice of Oncology. 10th. Philadelphia: Wolters Kluwer Health; 2014
• Thomas D, Henshaw R, Chawla S, Staddon A, Blay J, Roudier M. et al Denosumab in patients with giant-cell tumour of bone: an open-label, phase 2 study. Lancet Oncology 2010; 11 (03) 275-280
• Sobti A, Agrawal P, Agarwala S, Agarwal M.. Giant Cell Tumor of Bone - An Overview. Arch Bone Jt Surg 2016; 4 (01) 2-9
• Wu P, Tang WJ, Li K. RANK pathway in giant cell tumor of bone: pathogenis and therapeutic aspects. Tumor Biology 2015; 36 (02) 495-501
• NCCN. National comprehensive cancer network. . Clinical practice guidelines in oncology [Internet]. Bone cancer 2018 Available from: http://www.nccn.org
• FDA. Food and drug administration registration. 2018 Available from: https://www.accessdata.fda.gov/drugsatfda_docs/label/2013/125320s094lbl.pdf
• McCarthy CL, Gibbons CLMH, Bradley KM, Hassan AB, Giele H, Athanasou NA.. Giant cell tumour of the distal radius/ulna: response to pre-operative treatment with short-term denosumab. Clinical Sarcoma Research 2017; 7: 1-11
• Balke M, Schremper L, Gebert C, Ahrens H, Streitbuerger A, Koehler G. et al Giant ell tumor of bone: treatment and outcomes of 214 cases. Journal of Cancer Clinical Oncology 2008; 134 (09) 969-978