Denosumab in Giant Cell Tumour of Bone - A Case Series with Review of Literature

Abstract

Introduction: Giant Cell Tumour of Bone (GCTB) is an uncommon, locally aggressive primary bone neoplasm that may result in significant morbidity owing to its destructive growth pattern. Although intralesional curettage combined with local adjuvant therapy represents the current standard of care, this technique is associated with a relatively high incidence of local recurrence. Denosumab, a monoclonal antibody targeting RANKL (Receptor Activator of Nuclear Factor Kappa-B Ligand), has been shown to reduce tumor size, alleviate pain, and enable less extensive surgical procedures. It may also decrease the risk of recurrence and provide significant palliation in cases of metastatic or locally recurrent giant cell tumor of bone (GCTB).The series highlights the diverse clinical presentations, discusses evolving treatment strategies, and emphasizes the practical challenges faced by surgeons and oncologists in incorporating novel agents such as Denosumab into everyday practice.

Methods: This retrospective analysis focuses on patients diagnosed with GCTB and received Denosumab at the Department of Medical Oncology, Government medical College Kozhikode between November 2022 and December 2024. Data collection included demographics, clinical presentations, diagnostic findings, treatment modalities, and follow-up outcomes.

Results: The case series comprised various presentations, ranging from first presentation, recurrence to metastasis. 3 patients with localised disease underwent curettage with liquid nitrogen application and one patient underwent wide excision with reconstruction. Two patients who declined surgery continued on Denosumab with durable disease control. Two patients with symptomatic distant metastasis achieved symptomatic benefit and radiologic response with Denosumab therapy.

Conclusion: This case series confirms the findings of previous studies which shows that Denosumab reduces tumor size, alleviate pain, and enables less extensive surgical procedures in GCTB. It also helps to control disease in cases of metastatic and recurrent disease. This study highlights the real word challenges faced by clinicians and highlights the need for multidisciplinary team approach in the management of GCTB.