title: Giant cell tumors of the spine: has denosumab changed the treatment paradigm?
abstract: OBJECT Giant cell tumors (GCTs) of the spine are rare and complex to treat. They have a propensity for local recurrence and the potential to metastasize. Treatment is currently surgical and presents unique challenges due to the proximity of neural structures and the need for reconstruction. Denosumab has been shown in clinical trials to be an effective treatment for GCT, but has not yet been studied specifically in GCT of the spine or as a surgical adjunct. To the authors' knowledge this is the first such reported series. METHODS A multicenter, prospective series of 5 patients with GCT of the spine treated with denosumab were included. Patient demographic data, oncological history, neurological status, tumor staging, treatment details and adverse events, surgical procedure, complications, radiological and histological responses, and patient outcome were analyzed. RESULTS All patients were women, with a mean age of 38 years, and presented with pain; 2 patients had additional neurological signs and symptoms. The mean duration of symptoms was 62 weeks. No patient had a prior tumor or metastatic disease at presentation. All patients had Enneking Stage III tumors and were treated with monthly cycles of 120 mg of denosumab, with initial additional loading doses on Days 8 and 15. Patients were given daily supplements of calcium (500 mg) and vitamin D (400 IU). There were no denosumab-related adverse events. All patients had a radiological response to denosumab. One patient failed to have a histological response to denosumab, with > 90% of tumor cells found to be viable on histological investigation. CONCLUSIONS This study reports the early experience of using denosumab in the treatment of spinal GCT. The results demonstrate a clinically beneficial radiological response and an impressive histological response in most but not all patients. Further experience with denosumab and longer patient follow-up is required. Denosumab has the potential to change the treatment paradigm for spinal GCT.
authors.affiliation: Combined Neurosurgical and Orthopaedic Spine Program and.
authors.forename: Tony
authors.initials: T
authors.lastname: Goldschlager
authors.forename: Nicolas
authors.initials: N
authors.lastname: Dea
authors.forename: Michael
authors.initials: M
authors.lastname: Boyd
authors.forename: Jeremy
authors.initials: J
authors.lastname: Reynolds
authors.forename: Shreyaskumar
authors.initials: S
authors.lastname: Patel
authors.forename: Laurence D
authors.initials: LD
authors.lastname: Rhines
authors.forename: Ehud
authors.initials: E
authors.lastname: Mendel
authors.forename: Marina
authors.initials: M
authors.lastname: Pacheco
authors.forename: Edwin
authors.initials: E
authors.lastname: Ramos
authors.forename: Tobias A
authors.initials: TA
authors.lastname: Mattei
authors.forename: Charles G
authors.initials: CG
authors.lastname: Fisher
mesh_terms: D000328:Adult; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use*; D000069448:Denosumab; D005260:Female; D005870:Giant Cell Tumors / Q000188:drug therapy*; D006801:Humans; D008875:Middle Aged; D010147:Pain Measurement; D011446:Prospective Studies; D013125:Spinal Neoplasms / Q000188:drug therapy*; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000069448:Denosumab
keywords: ASIA = American Spinal Injury Association; GCT = giant cell tumor; RANKL = receptor activator of nuclear factor kappa B ligand; WBB = Weinstein-Boriani-Biagini; denosumab; en bloc resection; giant cell tumor; oncology; primary spine tumor