Efficacy of Neoadjuvant Denosumab on Tumor Recurrence, Ossification, and Surgical Outcomes in Patients With Grade III Giant Cell Tumor of Bone: A Prospective, Non-Randomized Comparative Interventional Study.

Karimi M, Pirzad S, Habibi K, Mirkazemi M

Journal ArticleAbstract only — full text under license

AI summary — for doctors, generated from the abstract only

Neoadjuvant denosumab before surgery for grade III giant cell tumor of bone led to ossification and fewer recurrences numerically, but the recurrence difference was not statistically significant.

What was studied

A prospective non-randomized comparison of 34 adults with Campanacci grade III giant cell tumor of bone, 16 given neoadjuvant denosumab and 18 treated with surgery alone, followed for 18 months.

Key findings

Local recurrence occurred in 12.5% (2/16) with denosumab versus 44.4% (8/18) without (p=0.063)
All denosumab patients had radiologic ossification versus none in the comparison group
Curettage and cementation were done in 87.5% versus 66.7% (p=0.233)
Pathology showed marked depletion of osteoclast-like giant cells with new bone formation and fibrosis

Clinical relevance

It supports denosumab's role in facilitating limb-sparing surgery in aggressive tumors.

Who should care

Medical Oncology

Limitations

A small non-randomized study with allocation by clinical decision, so selection bias is likely and recurrence differences were not significant.

Consider neoadjuvant denosumab to allow curettage in advanced giant cell tumor, recognizing recurrence benefit is unproven.

This is an AI-generated summary of the published abstract, not a clinical recommendation. It may not reflect the full text or subsequent updates — verify against the original source before acting on it.

Abstract

BACKGROUND

Giant cell tumor of bone (GCTB) is a rare, locally aggressive osteolytic neoplasm associated with a substantial risk of local recurrence and challenging surgical management. Denosumab, a monoclonal antibody, has emerged as a promising therapeutic option. This study evaluates the efficacy of denosumab as a neoadjuvant therapy in patients with Grade III GCTB, with particular emphasis on tumor recurrence, ossification, and surgical outcomes.

METHODS

In this prospective, non-randomized comparative interventional study, 34 adults with histologically confirmed Campanacci Grade III GCTB were enrolled and prospectively followed. Sixteen patients received neoadjuvant denosumab and 18 contemporaneous patients underwent surgery without neoadjuvant denosumab. Treatment allocation was based on routine clinical decision-making and patient-specific factors rather than randomization.

RESULTS

During the 18-month follow-up period, local recurrence occurred in 2 of 16 patients (12.5%) in the denosumab intervention group and in 8 of 18 patients (44.4%) in the comparison group (p = 0.063). Radiological ossification was observed in all patients in the denosumab group and in none of the patients in the comparison group. Curettage and cementation were performed in 14 patients (87.5%) in the intervention group and 12 patients (66.7%) in the comparison group; this difference was not statistically significant (p = 0.233). Qualitative histopathological assessment of available specimens from denosumab-treated patients demonstrated marked depletion or disappearance of osteoclast-like giant cells, accompanied by treatment-related changes including new bone formation, fibrosis, and hemorrhage.

CONCLUSION

In this study, neoadjuvant denosumab was associated with complete radiological ossification, qualitative histopathological changes characterized by marked depletion of osteoclast-like giant cells, and numerically lower observed local recurrence and greater use of curettage and cementation, although the latter two between-group differences were not statistically significant.

DOI

10.1111/ajco.70153

PMID

42595950

Research metadata (titles, abstracts, authors, publication dates) is sourced from Europe PMC, which aggregates content from PubMed/MEDLINE, PubMed Central, and other providers under the U.S. National Library of Medicine (NLM/NCBI). NLM does not claim copyright on abstracts; the original journal publishers or authors may hold rights to the full articles. AI-generated summaries are derived only from the abstract, never the full text, and are always labeled as AI-generated.

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