title: Current status and unanswered questions on the use of Denosumab in giant cell tumor of bone.
abstract: Denosumab is a monoclonal antibody to RANK ligand approved for use in giant cell tumour (GCT) of bone. Due to its efficacy, Denosumab is recommended as the first option in inoperable or metastatic GCT. Denosumab has also been used pre-operatively to downstage tumours with large soft tissue extension to allow for less morbid surgery. The role of Denosumab for conventional limb GCT of bone is yet to be defined. Further studies are required to determine whether local recurrence rates will be decreased with the adjuvant use of Denosumab along with surgery. The long term use and toxicity of this agent is unknown as is the proportion of patients with primary or secondary resistance. It is advised that complicated cases of GCT requiring Denosumab treatment should be referred and followed up at expert centres. Collaborative studies involving further clinical trials and rigorous data collection are strongly recommended to identify the optimum use of this drug.
authors.affiliation: Oncology Service, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham, B31 2AP UK.
authors.forename: Czar Louie
authors.initials: CL
authors.lastname: Gaston
authors.affiliation: Oncology Service, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham, B31 2AP UK.
authors.forename: Robert J
authors.identifier: 0000-0002-1510-4596
authors.initials: RJ
authors.lastname: Grimer
authors.affiliation: Oncology Service, Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Birmingham, B31 2AP UK.
authors.forename: Michael
authors.initials: M
authors.lastname: Parry
authors.affiliation: Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
authors.forename: Silvia
authors.initials: S
authors.lastname: Stacchiotti
authors.affiliation: Department of Anatomic Pathology, General Hospital of Treviso, Treviso, Italy.
authors.forename: Angelo Paolo
authors.initials: AP
authors.lastname: Dei Tos
authors.affiliation: Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Hans
authors.initials: H
authors.lastname: Gelderblom
authors.affiliation: Department of Oncology, Rizzoli Institute, Bologna, Italy.
authors.forename: Stefano
authors.initials: S
authors.lastname: Ferrari
authors.affiliation: Department of Cancer Medicine, S. Stefano Civil Hospital, Prato, Italy.
authors.forename: Giacomo G
authors.initials: GG
authors.lastname: Baldi
authors.affiliation: University of Washington/Fred Hutchinson Cancer Research Center, Seattle, WA USA ; Royal Marsden Hospital, London, UK.
authors.forename: Robin L
authors.initials: RL
authors.lastname: Jones
authors.affiliation: Sarcoma Oncology Center, Santa Monica, CA USA.
authors.forename: Sant
authors.initials: S
authors.lastname: Chawla
authors.affiliation: Department of Cancer Medicine, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Casali
authors.affiliation: Institut Gustave Roussy, Villejuif, France.
authors.forename: Axel
authors.initials: A
authors.lastname: LeCesne
authors.affiliation: Centre Leon Berard, Lyon, France.
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Blay
authors.affiliation: Leiden University Medical Center, Leiden, Netherlands.
authors.forename: Sander P D
authors.initials: SP
authors.lastname: Dijkstra
authors.affiliation: Garvan Institute of Medical Research, Sydney, Australia.
authors.forename: David M
authors.initials: DM
authors.lastname: Thomas
authors.affiliation: Department of Soft Tissue/Bone Sarcoma and Melanoma, Maria Sklodowska-Curie Memorial Center and Institute of Oncology, Warsaw, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Rutkowski
keywords: Denosumab; Giant cell tumor of bone; Inoperable; Neoadjuvant; Safety; Surgery