Malignancy in giant cell tumor of bone: analysis of an open-label phase 2 study of denosumab
Emanuela Palmerini, Leanne L Seeger, Marco Gambarotti, Alberto Righi, Peter Reichardt, Susan Bukata, Jean-Yves Blay, Tian Dai, Danielle Jandial, Piero Picci, Emanuela Palmerini, Leanne L Seeger, Marco Gambarotti, Alberto Righi, Peter Reichardt, Susan Bukata, Jean-Yves Blay, Tian Dai, Danielle Jandial, Piero Picci
Abstract
Background: Giant cell tumor of bone (GCTB) is a rare osteoclastogenic stromal tumor. GCTB can rarely undergo malignant transformation. This post hoc analysis evaluated and classified malignancies in patients with GCTB who received denosumab.
Methods: This analysis was conducted on patients with pathologically confirmed GCTB and measurable active disease treated with denosumab 120 mg subcutaneously once every 4 weeks, with loading doses on study days 8 and 15, as part of a phase 2, open-label, multicenter study. We identified potential cases of malignancy related to GCTB through an independent multidisciplinary review or medical history, associated imaging or histopathologic reports, and disease course. The findings were summarized and no statistical analysis was performed.
Results: Twenty of five hundred twenty-six patients (3.8%) who received at least one dose of denosumab were misdiagnosed with GCTB that was later discovered to be malignancies: five primary malignant GCTB, five secondary malignant GCTB, four sarcomatous transformations, and six patients with other malignancies (giant cell-rich osteosarcoma, undifferentiated pleomorphic sarcoma, spindle cell sarcoma, osteogenic sarcoma, phosphaturic mesenchymal tumor of mixed connective tissue type, and fibrosarcoma/malignant fibrous histiocytoma). Many malignancies were present before denosumab was initiated (8 definitive cases, 7 likely cases), excluding potential involvement of denosumab in these cases. Signs associated with potential misdiagnoses of GCTB included poor mineralization with denosumab treatment, rapid relapse in pain, or a failure of the typical dramatic improvement in pain normally observed with denosumab.
Conclusions: Although rare, GCTB can undergo malignant transformation, and rates in this study were consistent with previous reports. Signs of poor mineralization or lack of response to denosumab treatment may warrant close monitoring.
Trial registration: clinicaltrials.gov , ( NCT00680992 ). Registered May 20, 2008.
Keywords: Bone neoplasms; Denosumab; Giant cell tumor of bone; RANK ligand.
Conflict of interest statement
Dr. Palmerini has served on advisory boards for Amgen, Daiichi Sankyo, Lilly, EUSA Pharma, and Deciphera; has received other research support from Bristol-Myers Squibb, Pfizer, Daiichi Sankyo, and PharmaMar; and has received travel support from Lilly, PharmaMar, and Takeda.
Dr. Seeger reports nothing to disclose.
Drs. Gambarotti, Righi, and Picci received institutional funding from Amgen for clinical and pathological input and revision of the cases reported in this study.
Dr. Reichardt has received personal fees from Novartis, Pfizer, Bayer, PharmaMar, Clinigen, Lilly, Deciphera, Merck, Roche, and Amgen Inc.
Dr. Bukata has served as a consultant for Amgen and Radius, speakers’s bureau for Radius, and board service for the Orthopaedic Research Society and the US National Osteoporosis Foundation.
Dr. Blay has received research grants and honoraria from Novartis and Amgen Inc.
Drs. Dai and Jandial are employed by and own stock in Amgen Inc.
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