The Role of Denosumab in the Modern Treatment of Giant Cell Tumor of Bone

➢ Giant cell tumor of bone (GCTB) is a benign, locally aggressive, osteolytic lesion. Typical treatment involves extended intralesional curettage or en bloc resection. ➢ Denosumab is a fully human monoclonal antibody with inhibitory effects on RANKL (receptor activator of nuclear factor-κB ligand) that has shown early promise as a possible treatment adjuvant for GCTB. ➢ Current clinical trials of denosumab for GCTB have shown >85% clinical, radiographic, and histological responses. ➢ Case reports have demonstrated complete response or tumor stabilization with denosumab, allowing for less invasive surgical procedures. Current indications for denosumab in GCTB include lesions in the spine, sacrum, pelvis, and challenging lesions in upper and lower-extremity locations. ➢ Denosumab may be a therapeutic option in patients with unresectable or metastatic GCTB, but optimal length and dosing of treatment and long-term effects are unknown. Most concerning, potential rates of rapid recurrence post-treatment or pseudo-sarcomatous transformation following treatment cessation are still uncertain.