Managing Giant Cell Tumor of Bone: Denosumab Treatment and Side Effects

Giant Cell Tumor of Bone

Hello Doctor, in 2018, my father was diagnosed with a giant cell tumor of bone.
After the first surgery, it recurred, and a few months after the second surgery, we discovered that it had metastasized to the lungs.
He then started receiving denosumab, one injection per month, and has now received over 24 injections.
His condition has remained stable after the injections.
Recently, however, he has experienced skin itching, and I am unsure if it is related to denosumab.
I found that the typical treatment duration for denosumab is about two years.
Should my father stop the injections or continue? Thank you.

Su, 20~29 year old female. Ask Date: 2021/09/02

Dr. Chen Yongxue reply Orthopedics

Giant cell tumor of bone is essentially a benign bone tumor, but it can cause significant local bone destruction, has a tendency to recur, and in some cases may lead to pulmonary metastasis or transform into a malignant form.
When located near the sacrum, the presence of important neurovascular structures makes surgical intervention relatively challenging, and the likelihood of postoperative recurrence is higher.
Denosumab and bisphosphonates are among the more mainstream medications, although they are not specifically targeted for giant cell tumors.
If any side effects occur, it is advisable to discuss with the attending physician whether to switch medications.
Thank you.

Reply Date: 2021/09/02

More Info

Managing Giant Cell Tumor of Bone (GCT) can be quite complex, especially when considering treatment options like Denosumab. Denosumab is a monoclonal antibody that inhibits RANKL (Receptor Activator of Nuclear Factor Kappa-Β Ligand), which plays a crucial role in the formation, function, and survival of osteoclasts, the cells responsible for bone resorption. This medication has been primarily used for patients with unresectable GCT or those who are at high risk of recurrence after surgery.

In your father's case, it is notable that he has undergone two surgeries for GCT, with the second surgery followed by the discovery of pulmonary metastasis. The initiation of Denosumab treatment post-surgery is a common approach to help stabilize the disease and potentially reduce the risk of further complications. The fact that he has received over 24 injections and maintained stable disease is a positive indicator of the treatment's effectiveness.

However, the recent development of skin itching raises a valid concern regarding potential side effects associated with Denosumab. While Denosumab is generally well-tolerated, it can lead to various side effects, including skin reactions, hypocalcemia (low calcium levels), and osteonecrosis of the jaw (ONJ). The itching could be a benign reaction or a sign of an allergic response, but it is essential to discuss these symptoms with his healthcare provider to determine the appropriate course of action.

Regarding the duration of Denosumab treatment, there is no universally accepted standard, particularly for cases involving metastasis. The typical treatment course can vary significantly based on individual patient factors, including the extent of the disease, response to treatment, and side effects experienced. Some clinicians may recommend continuing Denosumab for an extended period, especially if the patient is responding well and not experiencing significant adverse effects. However, it is crucial to have regular follow-ups and assessments to monitor the disease and adjust treatment as necessary.

As for whether to continue or stop the injections, this decision should be made in consultation with your father's oncologist or the physician managing his GCT. They will consider his overall health, the stability of his condition, and any side effects he may be experiencing. If the itching is determined to be related to Denosumab, the physician may suggest pausing the treatment or switching to an alternative therapy.

In summary, Denosumab can be an effective treatment for GCT, especially in cases with a risk of recurrence or metastasis. Monitoring for side effects is essential, and any new symptoms should be promptly addressed with a healthcare provider. The decision to continue or discontinue treatment should be based on a thorough evaluation by the medical team, taking into account the benefits and risks associated with ongoing therapy. Regular communication with the healthcare team will ensure that your father receives the best possible care tailored to his specific needs.

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