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Histological Regression of Giant Cell Tumor of Bone Following RANK Ligand Inhibition.

Dietrich MF, Cavuoti D, Landay M, Arriaga YE - J Investig Med High Impact Case Rep (2014)

Bottom Line: Lung metastases are a rare complication of giant cell tumors of bone.We herein describe an interesting case of histological regression and size reduction of lung metastases originating from a primary giant cell tumor of bone in response to the RANK ligand inhibitor denosumab.

View Article: PubMed Central - PubMed

Affiliation: University of Texas Southwestern Medical Center, Dallas, TX, USA.

ABSTRACT
Lung metastases are a rare complication of giant cell tumors of bone. We herein describe an interesting case of histological regression and size reduction of lung metastases originating from a primary giant cell tumor of bone in response to the RANK ligand inhibitor denosumab.

No MeSH data available.


Related in: MedlinePlus

Computed tomography images of the chest are shown at baseline, 2, and 6 months after initiation of treatment with denosumab. Two representative lesions in the right upper lobe and left lower lobe are shown. The size of the shown lung nodules are smaller at 2 months of (B and E) treatment compared with baseline (A and D). No further shrinkage is seen after 4 additional months of treatment (C and F).
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fig1-2324709614560216: Computed tomography images of the chest are shown at baseline, 2, and 6 months after initiation of treatment with denosumab. Two representative lesions in the right upper lobe and left lower lobe are shown. The size of the shown lung nodules are smaller at 2 months of (B and E) treatment compared with baseline (A and D). No further shrinkage is seen after 4 additional months of treatment (C and F).

Mentions: The patient’s case was presented in our institutional tumor board, and a consensus decision was reached, recommending therapy with denosumab, based on results from phase II trials demonstrating safety and efficacy of denosumab in the treatment of metastatic giant cell tumors of bone (GCTBs).1,2 After comprehensive dental treatment, the patient was prescribed denosumab 120 mg via subcutaneous injection, with weekly loading doses on days 1, 8, and 15 of a 28-day cycle and then switched to 1 injection every 28 days.2 After 2 cycles of denosumab, contrast-enhanced CT scan of the chest showed reduction in size and number of all previously enlarged nodules, consistent with a partial response by RECIST 2.0 criteria (Figure 1). Several of these lung nodules that were not calcified initially became calcified on radiographic follow-up. A CT-guided core biopsy of one of the nodules after 2 cycles of denosumab showed histological response, with absence of giant cells (Figure 2). The patient received additional injections of denosumab without further shrinkage of the lung nodules after 4 and 6 cycles, respectively. She reported a significant improvement in her cough. There were no side effects noted or reported. The patient did not have denosumab-related serious adverse events such as osteonecrosis of the jaw or hypocalcemia. Currently, she receives maintenance subcutaneous injections of denosumab 120 mg every 28 days. Additionally, she has a physical examination and evaluation for denosumab-related toxicity every 3 months. Contrast-enhanced cross-sectional imaging of the chest is done every 6 months.


Histological Regression of Giant Cell Tumor of Bone Following RANK Ligand Inhibition.

Dietrich MF, Cavuoti D, Landay M, Arriaga YE - J Investig Med High Impact Case Rep (2014)

Computed tomography images of the chest are shown at baseline, 2, and 6 months after initiation of treatment with denosumab. Two representative lesions in the right upper lobe and left lower lobe are shown. The size of the shown lung nodules are smaller at 2 months of (B and E) treatment compared with baseline (A and D). No further shrinkage is seen after 4 additional months of treatment (C and F).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License 1 - License 2 - License 3
Show All Figures
getmorefigures.php?uid=PMC4528877&req=5

fig1-2324709614560216: Computed tomography images of the chest are shown at baseline, 2, and 6 months after initiation of treatment with denosumab. Two representative lesions in the right upper lobe and left lower lobe are shown. The size of the shown lung nodules are smaller at 2 months of (B and E) treatment compared with baseline (A and D). No further shrinkage is seen after 4 additional months of treatment (C and F).
Mentions: The patient’s case was presented in our institutional tumor board, and a consensus decision was reached, recommending therapy with denosumab, based on results from phase II trials demonstrating safety and efficacy of denosumab in the treatment of metastatic giant cell tumors of bone (GCTBs).1,2 After comprehensive dental treatment, the patient was prescribed denosumab 120 mg via subcutaneous injection, with weekly loading doses on days 1, 8, and 15 of a 28-day cycle and then switched to 1 injection every 28 days.2 After 2 cycles of denosumab, contrast-enhanced CT scan of the chest showed reduction in size and number of all previously enlarged nodules, consistent with a partial response by RECIST 2.0 criteria (Figure 1). Several of these lung nodules that were not calcified initially became calcified on radiographic follow-up. A CT-guided core biopsy of one of the nodules after 2 cycles of denosumab showed histological response, with absence of giant cells (Figure 2). The patient received additional injections of denosumab without further shrinkage of the lung nodules after 4 and 6 cycles, respectively. She reported a significant improvement in her cough. There were no side effects noted or reported. The patient did not have denosumab-related serious adverse events such as osteonecrosis of the jaw or hypocalcemia. Currently, she receives maintenance subcutaneous injections of denosumab 120 mg every 28 days. Additionally, she has a physical examination and evaluation for denosumab-related toxicity every 3 months. Contrast-enhanced cross-sectional imaging of the chest is done every 6 months.

Bottom Line: Lung metastases are a rare complication of giant cell tumors of bone.We herein describe an interesting case of histological regression and size reduction of lung metastases originating from a primary giant cell tumor of bone in response to the RANK ligand inhibitor denosumab.

View Article: PubMed Central - PubMed

Affiliation: University of Texas Southwestern Medical Center, Dallas, TX, USA.

ABSTRACT
Lung metastases are a rare complication of giant cell tumors of bone. We herein describe an interesting case of histological regression and size reduction of lung metastases originating from a primary giant cell tumor of bone in response to the RANK ligand inhibitor denosumab.

No MeSH data available.


Related in: MedlinePlus