Preoperative denosumab is associated with an increased risk of local recurrence in patients who undergo curettage surgery for grade 3 giant cell tumor of the bone (GCTB), according to research published in Annals of Surgical Oncology.
For this study, researchers reviewed medical records of 234 patients with GCTB who were surgically treated between 1990 and 2017. Of the total study population, 213 were treated without denosumab and 21 received preoperative denosumab.
In the overall cohort, 73.5% of patients underwent curettage, and 26.5% underwent en bloc resection. In the denosumab group, patients received a median of 5 cycles of denosumab, and the median duration of therapy was 14 weeks (IQR, 10-52 weeks).
The 3-year local recurrence-free survival (LRFS) rate was significantly lower among patients who received preoperative denosumab than among those treated with surgery alone — 35.3% and 79.9%, respectively (P <.001).
Among patients with Campanacci grade 3 tumors, the 3-year LRFS rate was significantly lower in the denosumab group compared with the non-denosumab group — 19.6% and 75.7%, respectively (P <.001).
However, among patients with grade 1 or 2 tumors, there was no significant difference in 3-year LRFS rates between the denosumab and non-denosumab groups — 75.0% and 82.7%, respectively (P =.606).
Among patients with grade 3 tumors who underwent curettage surgery, the 3-year LRFS rate was significantly decreased in the denosumab group compared with the non-denosumab group — 13.2% and 70.7%, respectively (P <.001).
However, the difference in 3-year LRFS between the 2 groups was not significant for patients with grade 3 tumors who underwent en bloc resection (P =.234).
“While these observations do not necessarily discourage the preoperative use of denosumab against GCTB, clinicians should be aware of the potentially increased risk of local recurrence when planning a curettage surgery after denosumab therapy,” the researchers wrote.
Asano N, Saito M, Kobayashi E, et al. Preoperative denosumab therapy against giant cell tumor of bone is associated with an increased risk of local recurrence after curettage surgery. Ann Surg Oncol. Published online February 17, 2022. doi:10.1245/s10434-022-11411-9