Repercussions of Denosumab in Patients With Giant Cell Tumor of Bone: An Observational Study

Binay K Rath; Amrit G; Pranati Mohanty; Aakankshya Tripathy; Jyoti Prakash Sahoo

doi:10.7759/cureus.48702

Repercussions of Denosumab in Patients With Giant Cell Tumor of Bone: An Observational Study

Cureus. 2023 Nov 12;15(11):e48702. doi: 10.7759/cureus.48702. eCollection 2023 Nov.

Authors

Binay K Rath¹, Amrit G¹, Pranati Mohanty², Aakankshya Tripathy³, Jyoti Prakash Sahoo⁴

Affiliations

¹ Orthopaedics, SCB Medical College and Hospital, Cuttack, IND.
² Pathology and Laboratory Medicine, SCB Medical College and Hospital, Cuttack, IND.
³ Pharmacology, SCB Medical College and Hospital, Cuttack, IND.
⁴ Pharmacology, Kalinga Institute of Medical Sciences, Bhubaneswar, IND.

Abstract

Background and objectives: The advent of denosumab has rendered giant cell tumors (GCT) of the bone amenable. It makes sense to evaluate its effect on the patient's symptoms and the histopathological outcomes. The aim of the study is to ascertain the effect of 24-week neoadjuvant denosumab therapy on the following parameters: visual analogue scale (VAS), musculoskeletal tumor society (MSTS) scores, tumor size, and the number of giant and stromal cells.

Material and methods: This observational study was conducted from February 2022 to April 2023 at SCB Medical College and Hospital, India. Fifty-four GCT participants had their VAS and MSTS scores assessed at baseline and then every four weeks for the next 24 weeks. At 24 weeks, changes in their tumor size and the number of giant and stromal cells per high-power field (hpf) were also evaluated.

Results: Fifty-four (82%) out of the 66 enrolled participants completed the study. Among those 54, 29 (54%) participants were female. The study population had a mean age of 39.0 ± 4.7 years. The median VAS scores were (female: 7.0, male: 7.0; p = 0.51) at baseline and (female: 2.0, male: 2.0; p = 0.39) at 24 weeks. The median MSTS scores at baseline and 24 weeks were (female: 8.0, male: 8.0; p = 0.41) and (female: 15.0, male: 16.0; p = 0.66), respectively. The median reductions in tumor size, the number of giant, and stromal cells (per hpf) were (female: 6.0 mm, male: 5.0 mm; p = 0.11), (female: 25, male: 27; p = 0.07), and (female: 1200, male: 2100; p < 0.001), respectively.

Conclusion: After receiving neoadjuvant denosumab for 24 weeks, the study participants' clinical symptoms and histological indicators improved. With the exception of the stromal cells, there was no statistically significant difference between the male and female participants.

Keywords: bone tumors; denosumab and giant cell tumor; giant cell tumour of bone; giant cells; musculoskeletal tumor society rating scale; neoadjuvant therapies; pain on vas; rank and rankl; stromal cells; visual analog scale.