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Near Complete Necrosis of a Giant Cell Tumor After Treatment with Denosumab: A Case Report.

Giant cell tumor of bone is an uncommon locally aggressive neoplasm accounting for 10% to 15% of all benign bone tumors1-3. The standard treatment has been surgical, with extended intralesional curettage utilizing either chemical or thermal adjuvants for tumors contained within the bone1-8. Tumors extending beyond the cortex with an associated soft-tissue mass are typically treated with wide resection1-9. If the tumor is near a joint, the reconstruction often involves an allograft or endoprosthetic replacement, which can lead to substantial disability and limitations in quality of life9,10. When located in the pelvis or spine, giant cell tumors can often be inoperable, or resection can result in considerable morbidity11-14. The recurrence rate of giant cell tumors has been reported to range from 7.9% to 27% with intralesional resection, despite the use of surgical adjuvants5-8, and from 0% to 7% when wide resection is performed5-8. External beam radiation has had limited success in the treatment of these patients15-17, and chemotherapeutic options have thus far been few and unsuccessful18-20.

In the last few years, the discovery that denosumab, a nuclear factor kappa-B ligand (RANKL) antibody, may have activity against giant cell activation has led to clinical trials of this drug for giant cell tumors of bone21-23. Thomas et al.24 reported a study of thirty-seven patients with recurrent or unresectable giant cell tumors who underwent treatment with denosumab, in which thirty of thirty-five patients (86%) had either histological improvement or improvement on imaging studies as a result of the RANKL inhibition.

We report the case of a patient with a large giant cell …