1
|
Tsukamoto S, Mavrogenis AF, Masunaga T, Honoki K, Fujii H, Kido A, Tanaka Y, Errani C. Current Concepts in the Treatment of Giant Cell Tumor of Bone: An Update. Curr Oncol 2024; 31:2112-2132. [PMID: 38668060 PMCID: PMC11048866 DOI: 10.3390/curroncol31040157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/01/2024] [Accepted: 04/05/2024] [Indexed: 04/28/2024] Open
Abstract
Curettage is recommended for the treatment of Campanacci stages 1-2 giant cell tumor of bone (GCTB) in the extremities, pelvis, sacrum, and spine, without preoperative denosumab treatment. In the distal femur, bone chips and plate fixation are utilized to reduce damage to the subchondral bone and prevent pathological fracture, respectively. For local recurrence, re-curettage may be utilized when feasible. En bloc resection is an option for very aggressive Campanacci stage 3 GCTB in the extremities, pelvis, sacrum, and spine, combined with 1-3 doses of preoperative denosumab treatment. Denosumab monotherapy once every 3 months is currently the standard strategy for inoperable patients and those with metastatic GCTB. However, in case of tumor growth, a possible malignant transformation should be considered. Zoledronic acid appears to be as effective as denosumab; nevertheless, it is a more cost-effective option. Therefore, zoledronic acid may be an alternative treatment option, particularly in developing countries. Surgery is the mainstay treatment for malignant GCTB.
Collapse
Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan; (T.M.); (K.H.); (H.F.); (Y.T.)
| | - Andreas F. Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street, Holargos, 15562 Athens, Greece;
| | - Tomoya Masunaga
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan; (T.M.); (K.H.); (H.F.); (Y.T.)
| | - Kanya Honoki
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan; (T.M.); (K.H.); (H.F.); (Y.T.)
| | - Hiromasa Fujii
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan; (T.M.); (K.H.); (H.F.); (Y.T.)
| | - Akira Kido
- Department of Rehabilitation Medicine, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan;
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara 634-8521, Nara, Japan; (T.M.); (K.H.); (H.F.); (Y.T.)
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136 Bologna, Italy;
| |
Collapse
|
2
|
Chen X, Ye F, He H, Chen G, Chen Z, Ye E, He B, Yang Y, Zhang J. Denosumab Induces Neoplastic Stromal Cell Apoptosis Via p62 Downregulation Dependent on Autophagy Pathway in Giant Cell Tumour of Bone. Curr Cancer Drug Targets 2024; 24:565-578. [PMID: 37961860 DOI: 10.2174/0115680096265253231022185008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 07/13/2023] [Accepted: 08/30/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND As the only humanized monoclonal antibody against receptor activator of nuclear factor-κB ligand (RANKL) for giant cell tumour of bone (GCTB) therapy, denosumab has limited antitumour effect on neoplastic stromal cells. Nevertheless, its mechanism of action has not yet been clarified. A previous study has revealed that p62 may play an important role in the antitumour activity of denosumab. OBJECTIVE The study aimed to investigate if the mechanism by which denosumab inhibits GCTB neoplastic stromal cells growth is via p62 modulation and other related mechanisms. METHODS p62 expression before and after denosumab therapy was analysed by RT‒qPCR, western blot, ELISA, and immunohistochemical assays. Two primary neoplastic stromal cells were isolated from fresh GCTB tumour tissue (L cell) and metastatic tissue (M cell). Cell proliferation, migration, apoptosis, and autophagy were investigated in p62 knockdown neoplastic stromal cells transfected by short hairpin RNA lentivirus in vitro. Tumor growth was evaluated in the chick chorioallantoic membrane model in vivo. RESULTS p62 expression was found to be downregulated following denosumab therapy. The patients with a decrease in p62 expression had lower recurrence-free survival rates. The proliferation of M cells was not inhibited by denosumab therapy, but it was restored by p62 knockdown. Moreover, p62 knockdown inhibited tumour growth in vivo. Denosumab induced M cell apoptosis and arrested the cell cycle at the G1/G0 transition and these effects were also enhanced by p62 knockdown. Autophagic flux assays revealed p62 modulation to be dependent on autophagy following denosumab incubation. CONCLUSION Denosumab induced neoplastic stromal cells apoptosis via p62 downregulation dependent on autophagy pathway. The combination of p62 and RANKL knockdown might be a better strategy than RANKL knockdown alone for GCTB targeted therapy.
Collapse
Affiliation(s)
- Xianwei Chen
- Department of Orthopaedics, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650118, China
| | - Fan Ye
- Department of Orthopaedics, The First Affiliated Hospital of Nanyang Medical College, Nangyang, Henan, 473000, China
| | - Hao He
- Department of Orthopaedics, The People's Hospital of Guang'an, Guang'an, Sichuan, 638000, China
| | - Gong Chen
- Department of Orthopaedics, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650118, China
| | - Zhifu Chen
- Department of Orthopaedics, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650118, China
| | - En Ye
- Department of Pathology, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650118, China
| | - Bingjan He
- Department of Orthopaedics, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650118, China
| | - Yuqi Yang
- Department of Orthopaedics, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650118, China
| | - Jing Zhang
- Department of Orthopaedics, Yunnan Cancer Hospital, The Third Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, 650118, China
| |
Collapse
|
3
|
Tan X, Zhang Y, Wei D, Yang Y, Xiang F. Denosumab for giant cell tumors of bone from 2010 to 2022: a bibliometric analysis. Clin Exp Med 2023; 23:3053-3075. [PMID: 37103655 DOI: 10.1007/s10238-023-01079-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Accepted: 04/17/2023] [Indexed: 04/28/2023]
Abstract
Giant cell tumors of the bone (GCTB) are considered moderately malignant bone tumors. Denosumab, as a neoadjuvant therapy, provides new possibilities for treating GCTB. However, even after multiple studies and long-term clinical trials, there are limitations in the treatment process. Research data and Medical Subject Headings terms related to denosumab and GCTB were collected from January 2010 to October 2022 using the Web of Science and MeSH ( https://meshb.nlm.nih.gov ) browsers. These data were imported into CiteSpace and VOSviewer softwares for bibliometric analysis. Overall, 445 publications on denosumab and GCTB were identified. Over the last 12 years, the growth rate of the total number of publications has remained relatively stable. The USA published the highest number of articles (83) and had the highest centrality (0.42). Amgen Inc. and Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) First Ortoped Rizzoli were identified as the most influential institutions. Many authors have made outstanding contributions to this field. Lancet Oncology had the highest journal impact factor (54.433). Local recurrence and drug dosage are current research hotspots, and future development trends will mainly focus on prognostic markers of GCTB and the development of new therapies. Further research is required to analyze denosumab's safety and efficacy and understand its local recurrence of GCTB, to identify the optimal dose. Future progress in this field will likely focus on exploring new diagnostic and recurrence markers to monitor disease progression and examine new therapeutic targets and treatment strategies.
Collapse
Affiliation(s)
- Xiaoqi Tan
- Department of Dermatology, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Yue Zhang
- Department of Orthopedic, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China
| | - Daiqing Wei
- Department of Orthopedic, Affiliated Hospital of Southwest Medical University, Luzhou, China
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China
| | - Yunkang Yang
- Department of Orthopedic, Affiliated Hospital of Southwest Medical University, Luzhou, China.
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China.
| | - Feifan Xiang
- Department of Orthopedic, Affiliated Hospital of Southwest Medical University, Luzhou, China.
- Sichuan Provincial Laboratory of Orthopaedic Engineering, Luzhou, China.
- Department of Nuclear Medicine, Affiliated Hospital of Southwest Medical University, Luzhou, China.
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, China.
- Institute of Nuclear Medicine, Southwest Medical University, Luzhou, China.
- State Key Laboratory of Quality Research in Chinese Medicine, Macau University of Science and Technology, Macau, China.
| |
Collapse
|
4
|
Anandan D, Kumar A, Jeyakkani MN, Inja DB, Jaiswal AK. Investigation of Giant Cell Tumor of Bone and Tissue Engineering Approaches for the Treatment of Giant Cell Tumor of Bone. ACS APPLIED BIO MATERIALS 2023; 6:3946-3958. [PMID: 37698377 DOI: 10.1021/acsabm.3c00441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Primary bone tumors such as Ewing sarcoma, osteosarcoma, and chondrosarcoma, secondary bone tumors developed from progressive malignancies, and metastasized bone tumors are more prevalent and studied descriptively through biology and medical research. Less than 0.2% of cancer diagnoses are caused by rare bone-originating tumors, which despite being rare are particularly difficult due to their high death rates and substantial disease burden. A giant cell tumor of bone (GCTB) is an intramurally invasive but rare and benign type of bone tumor, which seldom metastasizes. The most often prescribed medication for GCTB is Denosumab, a RANKL (receptor activator of nuclear factor κB ligand) inhibitor. Because pharmaceutical drug companies rely on two-dimensional and animal models, current approaches for investigating the diverse nature of tumors are insufficient. Cell line based medication effectiveness and toxicity studies cannot predict tumor response to antitumor medicines. It has already been investigated in detail why molecular pathways do not reproduce in vitro, a phenomenon known as flat biology. Due to physiological differences between human beings and animals, animal models do not succeed in identifying side effects of the treatment, emulating metastatic growth, and establishing the link between cancer and the immune system. This review summarizes and discusses GCTB, the disease, its cellular composition, various bone tumor models, and their properties and utilization in research. As a result, this study delves deep into in vitro testing, which is vital for scientists and physicians in various fields, including pharmacology, preclinical investigations, tissue engineering, and regenerative medicine.
Collapse
Affiliation(s)
- Dhivyaa Anandan
- Centre for Biomaterials, Cellular and Molecular Theranostics (CBCMT), Vellore Institute of Technology (VIT), Vellore 632014, Tamilnadu, India
| | - Amit Kumar
- Radiation Biology & Health Sciences Division, Bhabha Atomic Research Centre (BARC), Trombay, Mumbai 400085, Maharashtra, India
| | - Manasseh N Jeyakkani
- Department of Orthopaedics, Christian Medical College and Hospital, Vellore 632004, Tamilnadu, India
| | - Dan Barnabas Inja
- Department of Orthopaedics, Christian Medical College and Hospital, Vellore 632004, Tamilnadu, India
| | - Amit Kumar Jaiswal
- Centre for Biomaterials, Cellular and Molecular Theranostics (CBCMT), Vellore Institute of Technology (VIT), Vellore 632014, Tamilnadu, India
| |
Collapse
|
5
|
Yamaguchi M, Takami M, Azetsu Y, Karakawa A, Chatani M, Funatsu T, Sakai N. Effects of anti-RANKL antibodies administered to pregnant mice on bone and tooth development in neonates. J Oral Biosci 2023; 65:186-194. [PMID: 36907379 DOI: 10.1016/j.job.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 03/14/2023]
Abstract
OBJECTIVES This study examined how the anti-bone resorptive agent denosumab, which comprises anti-receptor activator of nuclear factor kappa B ligand (anti-RANKL) monoclonal antibodies, administered during pregnancy affected neonatal development. Anti-RANKL antibodies, which are known to bind to mouse RANKL and inhibit osteoclast formation, were administered to pregnant mice. Following this, the survival, growth, bone mineralization, and tooth development of their neonates were analyzed. METHODS Anti-RANKL antibodies (5 mg/kg) were injected into pregnant mice on day 17 of gestation. After parturition, their neonatal offspring underwent microcomputed tomography at 24 h and at 2, 4, and 6 weeks after birth. Three-dimensional bone and teeth images were subjected to histological analysis. RESULTS Approximately 70% of the neonatal mice born to mice who received anti-RANKL antibodies died within 6 weeks after birth. These mice had a significantly lower body weight and significantly higher bone mass compared with the control group. Furthermore, delayed tooth eruption and abnormal tooth morphology (eruption length, enamel surface, and cusps) were observed. Conversely, while the tooth germ shape and mothers against decapentaplegic homolog 1/5/8 expression remained unchanged at 24 h after birth in the neonatal mice born to mice that received anti-RANKL antibodies, osteoclasts were not formed. CONCLUSIONS These results suggest that anti-RANKL antibodies administered to mice in the late stage of pregnancy results in adverse events in their neonatal offspring. Thus, it is speculated that administering denosumab to pregnant humans will affect fetal development and growth after birth.
Collapse
Affiliation(s)
- Maho Yamaguchi
- Department of Pediatric Dentistry, Showa University School of Dentistry, 2-1-1 Kitasenzoku, Ota, Tokyo, 145-8515, Japan; Department of Pharmacology, Showa University School of Dentistry, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan; Pharmacological Research Center, Showa University, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan
| | - Masamichi Takami
- Department of Pharmacology, Showa University School of Dentistry, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan; Pharmacological Research Center, Showa University, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan.
| | - Yuki Azetsu
- Department of Pharmacology, Showa University School of Dentistry, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan; Pharmacological Research Center, Showa University, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan
| | - Akiko Karakawa
- Department of Pharmacology, Showa University School of Dentistry, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan; Pharmacological Research Center, Showa University, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan
| | - Masahiro Chatani
- Department of Pharmacology, Showa University School of Dentistry, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan; Pharmacological Research Center, Showa University, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan
| | - Takahiro Funatsu
- Department of Pediatric Dentistry, Showa University School of Dentistry, 2-1-1 Kitasenzoku, Ota, Tokyo, 145-8515, Japan
| | - Nobuhiro Sakai
- Department of Pharmacology, Showa University School of Dentistry, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan; Pharmacological Research Center, Showa University, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan; Department of Dental Education, Showa University School of Dentistry, 1-5-8 Hatanodai, Shinagawa, Tokyo, 142-8555, Japan.
| |
Collapse
|
6
|
Tsukamoto S, Hindiskere S, Honoki K, Mavrogenis AF, Tanaka Y, Chinder PS, Donati DM, Errani C. Outcome of re-operation for local recurrence following pre-operative denosumab administration and curettage for giant cell tumour of bone with difficult joint preservation. INTERNATIONAL ORTHOPAEDICS 2023; 47:265-273. [PMID: 36282294 DOI: 10.1007/s00264-022-05613-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 10/13/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Denosumab enables joint-sparing surgery (curettage) and surgical downstaging in patients with giant cell tumour of bone (GCTB), where joint preservation is not possible. However, denosumab treatment causes osteosclerosis of the lesion, making it difficult to curet the lesion, leaving the tumour behind, and increasing the local recurrence rate. We performed a three-centre retrospective study to investigate the postoperative local re-recurrence rate, joint preservation status, and functional outcomes of locally recurrent lesions after preoperative denosumab treatment and curettage in patients with difficult joint preservation. METHODS We included 38 of 142 patients with primary GCTB of the extremities who underwent preoperative denosumab and curettage between 2009 and 2021 with local recurrence. Preoperative denosumab was indicated in patients with minimal residual periarticular and subchondral bones, large extraosseous lesions (Campanacci stage 3), and pathological fractures that made joint preservation difficult. RESULTS Local re-recurrence occurred in 6 (15.8%) of the 38 patients. In 29 patients who underwent re-curettage, local re-recurrence occurred in six patients (20.7%); however, in nine patients who underwent en bloc resection, no local re-recurrence was observed. The joint preservation rate was 63.2% (24 of 38 patients), with a median Musculoskeletal Tumor Society score of 28 (interquartile range: 26.8-29.0). The median follow-up period after surgery for local recurrence was 63.5 months (interquartile range: 42.5-82.4). CONCLUSION Since the local re-recurrence rate after re-curettage for local recurrence was low, and the joint preservation rate and affected limb function were good, preoperative denosumab administration may be considered in patients who require downstaging to maintain good limb function (joint preservation).
Collapse
Affiliation(s)
- Shinji Tsukamoto
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-City, Nara, 634-8521, Japan.
| | - Suraj Hindiskere
- Department of Musculoskeletal Oncology, HCG Hospital, No. 8, P. Kalingarao Road, Sampangiramnagar, Bangalore, Karnataka, 560027, India.,The Yellow Ribbon, #805, 2nd floor, 9th Main, 4th Block, Jayanagar, Bangalore, 560011, India
| | - Kanya Honoki
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-City, Nara, 634-8521, Japan
| | - Andreas F Mavrogenis
- First Department of Orthopaedics, School of Medicine, National and Kapodistrian University of Athens, 41 Ventouri Street, 15562, Holargos, Athens, Greece
| | - Yasuhito Tanaka
- Department of Orthopaedic Surgery, Nara Medical University, 840, Shijo-cho, Kashihara-City, Nara, 634-8521, Japan
| | - Pramod S Chinder
- Department of Musculoskeletal Oncology, HCG Hospital, No. 8, P. Kalingarao Road, Sampangiramnagar, Bangalore, Karnataka, 560027, India.,The Yellow Ribbon, #805, 2nd floor, 9th Main, 4th Block, Jayanagar, Bangalore, 560011, India
| | - Davide Maria Donati
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| | - Costantino Errani
- Department of Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Via Pupilli 1, 40136, Bologna, Italy
| |
Collapse
|
7
|
Pape J, Bakkalci D, Hosni RA, Simpson BS, Heikinheimo K, Fedele S, Cheema U. RANKL neutralisation prevents osteoclast activation in a human in vitro ameloblastoma-bone model. J Tissue Eng 2022; 13:20417314221140500. [PMID: 36582941 PMCID: PMC9793035 DOI: 10.1177/20417314221140500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 11/05/2022] [Indexed: 12/25/2022] Open
Abstract
Ameloblastoma is a benign, locally invasive epithelial odontogenic neoplasm of the jaw. Treatment of choice is jaw resection, often resulting in significant morbidity. The aim of this study was to recapitulate ameloblastoma in a completely humanised 3D disease model containing ameloblastoma cells, osteoblasts and activated osteoclasts to investigate the RANKL pathway within the ameloblastoma stromal environment and its response to the RANKL antibody denosumab. In vitro bone was engineered by culturing human osteoblasts (hOB) in a biomimetic, dense collagen type I matrix, resulting in extensive mineral deposits by day 21 forming alizarin red positive bone like nodules throughout the 3D model. Activated TRAP + human osteoclasts were confirmed through the differentiation of human CD14+ monocytes after 10 days within the model. Lastly, the ameloblastoma cell lines AM-1 and AM-3 were incorporated into the 3D model. RANKL release was validated through TACE/ADAM17 activation chemically or through hOB co-culture. Denosumab treatment resulted in decreased osteoclast activation in the presence of hOB and ameloblastoma cells. These findings stress the importance of accurately modelling tumour and stromal populations as a preclinical testing platform.
Collapse
Affiliation(s)
- Judith Pape
- UCL Centre for 3D Models of Health and
Disease, Division of Surgery and Interventional Science, University College London,
London, UK
| | - Deniz Bakkalci
- UCL Centre for 3D Models of Health and
Disease, Division of Surgery and Interventional Science, University College London,
London, UK
| | - Rawiya Al Hosni
- UCL Centre for 3D Models of Health and
Disease, Division of Surgery and Interventional Science, University College London,
London, UK
| | - Benjamin S Simpson
- Research Department of Targeted
Intervention, Division of Surgery and Interventional Science, University College
London, London, UK
| | - Kristiina Heikinheimo
- Department of Oral and Maxillofacial
Surgery, Institute of Dentistry, University of Turku and Turku University Hospital,
Turku, Finland
| | - Stefano Fedele
- Eastman Dental Institute, Oral Medicine
Unit, University College London, London, UK
| | - Umber Cheema
- UCL Centre for 3D Models of Health and
Disease, Division of Surgery and Interventional Science, University College London,
London, UK,Umber Cheema, UCL Centre for 3D Models of
Health and Disease, Division of Surgery and Interventional Science, University
College London, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK.
| |
Collapse
|
8
|
Jiang X, Chen J, Zhou W, Zhang C, Wang G, Dong D, Xia P, Liu X, Xu F. Microwave in situ inactivation in the treatment of bone giant cell tumor: a mid-term descriptive study. J Cancer Res Clin Oncol 2022:10.1007/s00432-022-04348-9. [PMID: 36190550 DOI: 10.1007/s00432-022-04348-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 09/06/2022] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the mid-term clinical efficacy of microwave in situ inactivation combined with bone grafting or polymethyl methacrylate (PMMA) filling in the treatment of giant cell tumor of bone (GCTB). METHODS This is a retrospective, descriptive, and analytical study. A total of 30 GCTB patients received microwave in situ inactivation from January 2012 to January 2020, whose clinical recurrence rate was evaluated at the last follow-up after microwave in situ inactivation surgery. The Musculoskeletal Tumor Society (MSTS) function score was used to evaluate the postoperative clinical panoramic results. RESULTS All patients were followed up for 21 to 110 months, with an average of 63.79 months. Distal femur (40%) and proximal tibia (28%) had a higher rate of GCTB incidence. Seventeen percent of tumor patients suffered from associated pathologic fracture. The rate of Campanacci classification stage III was 60%. The average MSTS score was evaluated as 27.53 points overall at the last follow-up. In terms of complications, three, two, two and one cases developed fat liquefaction, controllable tissue rejection reaction, incision infection and degenerative changes around lesion joint, respectively, without in situ recurrences and reoperation as well as distant lung metastasis. CONCLUSIONS The method of microwave in situ inactivation combined with bone grafting or PMMA filling is prudently recommended as one of the options for the limb salvage treatment of giant cell tumor of long and periarticular bone. LEVEL OF EVIDENCE IV: case series.
Collapse
Affiliation(s)
- Xiang Jiang
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Jianan Chen
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
- The First School of Clinical Medicine, Southern Medical University, 1023-1063 Shatai South Road, Baiyun District, Guangzhou City, Guangdong Province, China
| | - Wei Zhou
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Chen Zhang
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Guodong Wang
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Dan Dong
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Pingguang Xia
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China.
| | - Ximing Liu
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| | - Feng Xu
- Department of Orthopedics, General Hospital of Central Theater Command, 627 Wuluo Road, Hongshan District, Wuhan City, Hubei Province, China
| |
Collapse
|
9
|
Ren B, Ren X, Wang L, Tu C, Zhang W, Liu Z, Qi L, Wan L, Pang K, Tao C, Li Z. A bibliometric research based on hotspots and frontier trends of denosumab. Front Pharmacol 2022; 13:929223. [PMID: 36199692 PMCID: PMC9527327 DOI: 10.3389/fphar.2022.929223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Denosumab is a monoclonal antibody that targets and inhibits the osteoclast activating factor receptor activator for nuclear factor-κB ligand (RANKL). It has been widely used in the treatment of osteoporosis, giant cell tumors of bone, and in the prevention of malignant skeletal-related events (SREs). We collected the research results and related MeSH terms of denosumab from 2011 to 2021 through the Web of Science and PubMed, respectively. The literature was visualized and analyzed by CiteSpace and bibliometric online analysis platforms. The MeSH terms were biclustered using the Bibliographic Co-Occurrence Analysis System (BICOMB) and graph clustering toolkit (gCLUTO). The results show that the number of denosumab-related annual publications had increased from 51 to 215, with the United States leading and Amgen Inc. being the most influential in the past 10 years. Articles published in the Journal of Bone and Mineral Research had the highest total citations. Three scholars from Shinshu University in Matsumoto, Yukio Nakamura, Takako Suzuki, and Hiroyuki Kato, joined the field relatively late but produced the most. The clinical comparison and combination of denosumab with other drugs in the treatment of osteoporosis was the most significant focus of research. Drug withdrawal rebound and management strategies have gained more attention and controversy recently. MeSH analysis revealed eight major categories of research hotspots. Among them, exploring the multiple roles of the RANK-RANKL-OPG system in tumor progression, metastasis, and other diseases is the potential direction of future mechanism research. It is a valuable surgical topic to optimize the perioperative drug administration strategy for internal spinal fixation and orthopedic prosthesis implantation. Taken together, the advantages of denosumab were broad and cost-effective. However, there were still problems such as osteonecrosis of the jaw, severe hypocalcemia, a high recurrence rate of giant cells in the treatment of bone and individual sarcoidosis, and atypical femoral fractures, which need to be adequately solved.
Collapse
Affiliation(s)
- Bolin Ren
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Xiaolei Ren
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lu Wang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Chao Tu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Wenchao Zhang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Zhongyue Liu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lin Qi
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Lu Wan
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ke Pang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Cheng Tao
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Cheng Tao, ; Zhihong Li,
| | - Zhihong Li
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Tumor Models and Individualized Medicine, The Second Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Cheng Tao, ; Zhihong Li,
| |
Collapse
|
10
|
Wang B, Zhan Y, Yan L, Hao D. How zoledronic acid improves osteoporosis by acting on osteoclasts. Front Pharmacol 2022; 13:961941. [PMID: 36091799 PMCID: PMC9452720 DOI: 10.3389/fphar.2022.961941] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 07/22/2022] [Indexed: 11/23/2022] Open
Abstract
Osteoporosis is called a silent disease, because it is difficult to detect until comprehensive examinations for osteoporosis are performed or osteoporotic fractures occur. Zoledronic acid is currently the first-line anti-osteoporotic drug, with good efficacy and treatment compliance. A major advantage of zoledronic acid is that intravenous zoledronic acid often guarantees a therapeutic effect for up to 1 year after infusion. The reasons why zoledronic acid is effective in improving osteoporosis are that it can inhibit osteoclast differentiation and induce osteoclast apoptosis, thus suppressing bone resorption and increasing bone density. The story between zoledronic acid and osteoclasts has been written long time ago. Both the canonical receptor activator of the receptor activator of nuclear factor-κB ligand (RANKL) pathway and the non-canonical Wnt pathway are the main pathways by which zoledronic acid inhibits osteoclast differentiation. Farnesyl pyrophosphate synthase (FPPS), reactive oxygen species (ROS), and ferroptosis that was first proposed in 2012, are all considered to be closely associated with zoledronic acid-induced osteoclast apoptosis. Here, we provide a brief review of the recent progress on the study of zoledronic acid and osteoclasts, and hope to elaborate how zoledronic acid improves osteoporosis by acting on osteoclasts.
Collapse
Affiliation(s)
- Biao Wang
- Spine Surgery, Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an, China
| | - Yi Zhan
- Spine Surgery, Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an, China
- The Sceond Clinical Medical College of Shaanxi University of Chinese Medicine, Xi’an, China
| | - Liang Yan
- Spine Surgery, Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Dingjun Hao, ; Liang Yan,
| | - Dingjun Hao
- Spine Surgery, Honghui Hospital Affiliated to Xi’an Jiaotong University, Xi’an, China
- *Correspondence: Dingjun Hao, ; Liang Yan,
| |
Collapse
|
11
|
Abstract
PURPOSE OF REVIEW Giant cell tumors of bone (GCTB) are intermediate, locally aggressive primary bone tumors. For conventional GCTB, surgery remains treatment of choice. For advanced GCTB, a more important role came into play for systemic therapy including denosumab and bisphosphonates over the last decade. RECENT FINDINGS In diagnostics, focus has been on H3F3A (G34) driver mutations present in GCTB. The most frequent mutation (G34W) can be detected using immunohistochemistry and is highly specific in differentiating GCTB from other giant cell containing tumors. PD-L1 expression can be used as biological marker to predict higher recurrence risks in GCTB patients.The use of bisphosphonate-loaded bone cement is under investigation in a randomized controlled trial. A new technique consisting of percutaneous microwave ablation and bisphosphonate-loaded polymethylmethacrylate cementoplasty was proposed for unresectable (pelvic) GCTB.Increased experience with use of denosumab raised concern on elevated recurrence rates. However, conclusions of meta-analyses should be interpreted with risk of indication bias in mind. Several small studies are published with short-course denosumab (varying from 3 to 6 doses). One small trial directly compared denosumab and zoledronic acid, with no statistical differences in radiological and clinical outcome, and nonsignificantly higher recurrence rate after denosumab. As bisphosphonates directly target neoplastic stromal cells in GCTB, larger directly comparative trials are still warranted. SUMMARY Neoadjuvant denosumab is highly effective for advanced GCTB, and a short-course is advised to facilitate surgery, whereas increased recurrence rates remain of concern. Randomized controlled trials are conducted on bisphosphonate-loaded bone cement and on optimal dose and duration of neoadjuvant denosumab. PD-L1 could be a potential new therapy target in GCTB.
Collapse
|
12
|
Yue J, Sun W, Li S. Denosumab Versus Zoledronic Acid in Cases of Surgically Unsalvageable Giant Cell Tumor of Bone: A Randomized Clinical Trial. J Bone Oncol 2022; 35:100441. [PMID: 35800292 PMCID: PMC9254448 DOI: 10.1016/j.jbo.2022.100441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 11/24/2022] Open
Abstract
Denosumab and zoledronic acid had similar tumor responses and clinical benefits. Disease progression was observed in patients in the DB group (12.5%) than ZA group (15.0%). Denosumab treatment was markedly more expensive than zoledronic acid treatment (p < 0.0001). The recurrence-free survival rate at 4-year follow-up is higher in DB group (p = 0.035).
Background Giant-cell tumor of bone (GCTB) is a relatively benign, but locally aggressive osteoclastogenic stromal tumour of the bone. Although denosumab has been approved as an monoclonal antibody against RANK ligand for the treatment of GCTB, few clinical trials of the benefit in tumor response have been conducted to prove the efficiency in Chinese population. Objectives In this multicentric, random controlled, clinical trial, 160 patients were enrolled to compare the therapeutic efficacy and safety of denosumab and zoledronic acid treatment in patients with surgically unsalvageable GCTB. Methods Between 2nd Jan 2015 and 1st Jan 2018, 160 adults (aged ≥ 18 years) with ①surgically unsalvageable GCTB, ②surgically salvageable GCTB with planned surgery expected to result in severe morbidity were included in this randomized clinical trial. Patients received either subcutaneous denosumab (DB group; 120 mg once every 4 weeks with loading doses of 120 mg subcutaneously admininstered on days 8 and 15; n = 80) or intravenous zoledronic acid (ZA group; 4 mg once every 4 weeks; n = 80) for six cycles. Disease status, clinical benefits, treatment-emergent adverse effects, overall survival, and cost of treatment were evaluated during the follow-up period. Statistical significance was determined using 95% confidence intervals. Results Denosumab and zoledronic acid had similar tumor responses (p = 0.118) and clinical benefits (p = 0.574). Disease progression was observed in fewer patients in the DB group (12.5%) than ZA group (15.0%). Denosumab caused fatigue (p = 0.001) and back pain (p < 0.0001), while zoledronic acid caused hypocalcemia (p < 0.0001), flu-like symptoms (p = 0.059) and hypotension (p = 0.059). Denosumab treatment was markedly more expensive than zoledronic acid treatment (p < 0.0001). The cost to manage treatment-emergent adverse effects was the same for the ZA group and the DB group (p = 0.425). The accumulate recurrence-free survival rate at 4-year follow-up is higher in DB group (p = 0.035). Conclusions Denosumab is a safe but costly alternative to zoledronic acid for treatment of surgically unsalvageable GCTB.
Collapse
|
13
|
Yang Y, Xu H, Liu W, Niu X. Study of imaging changes following preoperative denosumab for giant cell tumor of bone. J Bone Oncol 2022; 32:100410. [PMID: 35059284 PMCID: PMC8760557 DOI: 10.1016/j.jbo.2021.100410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 12/24/2021] [Accepted: 12/28/2021] [Indexed: 11/24/2022] Open
Abstract
The preoperative application of denosumab can reduce tumor blood supply. The decrease of blood supply was the most significant in the initial stage of treatment. It is not recommended to apply denosumab long before surgical treatment.
Background The changes in the characteristics of the tumor blood supply of giant cell tumor of bone over time after treatment with denosumab remain unclear. The purpose of this study was to evaluate the change in the blood supply imaging characteristics of giant cell tumor of bone after preoperative denosumab treatment and to provide evidence for evaluating the reasonable time for preoperative treatment. Methods A total of 59 patients with giant cell tumor of bone who were treated in our hospital from 2014 to 2019 were enrolled in the study. All patients underwent enhanced CT examination of the tumor site before denosumab treatment and every month after treatment. The plain CT value and enhanced CT value of the tumor were measured, and the CT enhancement rate of the tumor was calculated. The change in the CT enhancement rate of the tumor over time after denosumab treatment was analyzed. Results The average tumor enhancement rates were 2.14 (1.22–4.05), 1.60 (1.12–2.53), 1.38 (1.02–2.24), and 1.25 (1–2.11) before denosumab treatment and one month, three months, and six months after treatment, respectively. After denosumab treatment, the average monthly CT enhancement rate decreased as follows: 0.54 (25.2%) in the first month, 0.11 (5.15%) in the second to third months, and 0.04 (1.87%) in the fourth to sixth months. The tumor enhancement rate was no longer significantly reduced three months post-treatment. There was a significant correlation between the reduction in the CT enhancement rate and the initial CT enhancement rate (P = 0.000). Conclusion The preoperative application of denosumab can reduce tumor blood supply. The decrease in the blood supply is the most significant in the initial stage of treatment. Following treatment, the decrease in the blood supply gradually reduces over time. Therefore, for the purpose of reducing intra-operative bleeding and facilitating surgery, application of denosumab treatment is not recommended more than three months before surgery.
Collapse
|
14
|
Kanwat H, Banjara R, Kumar VS, Majeed A, Gamnagatti S, Khan SA. Comparison of Denosumab and Zoledronic acid as neoadjuvant therapy in patients with giant cell tumor of bone. J Orthop Surg (Hong Kong) 2021; 29:23094990211007565. [PMID: 34231432 DOI: 10.1177/23094990211007565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES Both Zoledronic acid and denosumab have been utilized in neo-adjuvant setting for facilitating surgery and downsizing the lesion in Giant cell tumor (GCT). This study is aimed at comparing Zoledronic acid and Denosumab, when used in neo-adjuvant setting, in terms of radiological and clinical outcomes in GCT undergoing surgical intervention. PATIENTS AND METHODS Patients undergoing surgical intervention for GCT who received either denosumab or Zoledronic acid as neoadjuvant agents were retrospectively analyzed for reduction in tumor load radiologically, change in surgical plan after therapy, facilitation of surgery, therapy related complications, cost of treatment, rate of local recurrence and clinical outcomes. RESULTS Twenty patients received denosumab and 19 patients received Zoledronic acid as neoadjuvant agent. There was no significant difference in radiological outcomes, facilitation of surgery and clinical outcomes at end of follow-up. Zoledronic acid group had lower number of recurrences, however, not statistically significant. Therapy with Zoledronic acid was significantly cheaper (p = 0.001). CONCLUSION Zoledronic acid is a cheaper alternative to denosumab in terms of solidification of lesion, reducing recurrence rates and improving clinical outcomes. Larger prospective studies required to further delineate this outcome with Zoledronic acid.
Collapse
Affiliation(s)
- Himanshu Kanwat
- Department of Orthopaedics, All India Institute of medical sciences, New Delhi, India
| | - Roshan Banjara
- Department of Orthopaedics, All India Institute of medical sciences, New Delhi, India
| | | | - Abdul Majeed
- Department of Orthopaedics, All India Institute of medical sciences, New Delhi, India
| | - Shivanand Gamnagatti
- Department of Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India
| | - Shah Alam Khan
- Department of Orthopaedics, All India Institute of medical sciences, New Delhi, India
| |
Collapse
|
15
|
Feng W, He M, Jiang X, Liu H, Xie T, Qin Z, Huang Q, Liao S, Lin C, He J, Xu J, Ma J, Liu Y, Wei Q. Single-Cell RNA Sequencing Reveals the Migration of Osteoclasts in Giant Cell Tumor of Bone. Front Oncol 2021; 11:715552. [PMID: 34504794 PMCID: PMC8421549 DOI: 10.3389/fonc.2021.715552] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 08/03/2021] [Indexed: 12/22/2022] Open
Abstract
Giant cell tumor of bone (GCTB) is benign tumor that can cause significant osteolysis and bone destruction at the epiphysis of long bones. Osteoclasts are thought to be highly associated with osteolysis in GCTB. However, the migration of osteoclasts in GCTB remains unclear. A deeper understanding of the complex tumor microenvironment is required in order to delineate the migration of osteoclasts in GCTB. In this study, samples were isolated from one patient diagnosed with GCTB. Single-cell RNA sequencing (scRNA-seq) was used to detect the heterogeneity of GCTB. Multiplex immunofluorescence staining was used to evaluate the cell subtypes identified by scRNA-seq. A total of 8,033 cells were obtained from one patient diagnosed with GCTB, which were divided into eight major cell types as depicted by a single-cell transcriptional map. The osteoclasts were divided into three subsets, and their differentiation trajectory and migration status were further analyzed. Osteoclast migration may be regulated via a series of genes associated with cell migration. Furthermore, four signaling pathways (RANKL, PARs, CD137 and SMEA3 signaling pathway) were found to be highly associated with osteoclast migration. This comprehensive single-cell transcriptome analysis of GCTB identified a series of genes associated with cell migration as well as four major signaling pathways that were highly related to the migration of osteoclasts in GCTB. Our findings broaden the understanding of GCTB bionetworks and provides a theoretical basis for anti-osteolysis therapy against GCTB in the future.
Collapse
Affiliation(s)
- Wenyu Feng
- Department of Trauma Orthopedic and Hand Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Mingwei He
- Department of Trauma Orthopedic and Hand Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Guangxi Collaborative Innovation Center for Biomedicine, Guangxi Medical University, Nanning, China
| | - Xiaohong Jiang
- Department of Trauma Orthopedic and Hand Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China.,Department of Orthopedic, Affiliated Minzu Hospital of Guangxi Medical University, Nanning, China
| | - Huijiang Liu
- Department of Orthopedics, The First People's Hospital of Nanning, Nanning, China
| | - Tianyu Xie
- Department of Trauma Orthopedic and Hand Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhaojie Qin
- Department of Spinal Bone Disease, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qian Huang
- Department of Trauma Orthopedic and Hand Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Shijie Liao
- Department of Trauma Orthopedic and Hand Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Chengsen Lin
- Department of Trauma Orthopedic and Hand Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Juliang He
- Department of Bone and Soft Tissue Surgery, Guangxi Medical University Cancer Hospital, Nanning, China
| | - Jiake Xu
- School of Biomedical Sciences, The University of Western Australia, Perth, WA, Australia
| | - Jie Ma
- Department of Medical Oncology, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Yun Liu
- Department of Spinal Bone Disease, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Qingjun Wei
- Department of Trauma Orthopedic and Hand Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning, China
| |
Collapse
|
16
|
Wang X, Su P, Kang Y, Xu C, Qiu J, Wu J, Sheng P, Huang D, Zhang Z. Combination of Melatonin and Zoledronic Acid Suppressed the Giant Cell Tumor of Bone in vitro and in vivo. Front Cell Dev Biol 2021; 9:690502. [PMID: 34447747 PMCID: PMC8382950 DOI: 10.3389/fcell.2021.690502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/20/2021] [Indexed: 11/13/2022] Open
Abstract
Melatonin (Mlt) confers potential antitumor effects in various types of cancer. However, to the best of our knowledge, the role of Mlt in the giant cell tumor of bone (GCTB) remains unknown. Moreover, further research is required to assess whether Mlt can enhance the therapeutic effect of zoledronic acid (Zol), a commonly used anti-GCTB drug. In this research, we investigated the effects of Mlt, Zol, and the combination of these two drugs on GCTB cells’ characteristics, including cell proliferation, apoptosis, osteogenic differentiation, migration, and invasion. The cell counting kit-8 (CCK-8) assay, colony formation assay, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling assay (TUNEL), alkaline phosphatase (ALP) staining, alizarin red staining (ARS), scratch wound healing assay, and transwell experiment were performed, respectively. Our results showed that Mlt could effectively inhibit the proliferation, migration, and invasion of GCTB cells, as well as promote the apoptosis and osteogenic differentiation of tumor cells. Of note, a stronger antitumor effect was observed when Mlt was combined with Zol treatment. This therapeutic effect might be achieved by inhibiting the activation of both the Hippo and NF-κB pathways. In conclusion, our study suggests that Mlt can be a new treatment for GCTB, which could further enhance the antitumor effect of Zol.
Collapse
Affiliation(s)
- Xudong Wang
- Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Peiqiang Su
- Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yan Kang
- Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Caixia Xu
- Research Centre for Translational Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jincheng Qiu
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Jinna Wu
- Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Puyi Sheng
- Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| | - Dongsheng Huang
- Department of Orthopedics, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Ziji Zhang
- Department of Orthopedics, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Orthopedics and Traumatology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
| |
Collapse
|
17
|
Current Concepts in the Treatment of Giant Cell Tumors of Bone. Cancers (Basel) 2021; 13:cancers13153647. [PMID: 34359548 PMCID: PMC8344974 DOI: 10.3390/cancers13153647] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2021] [Revised: 07/19/2021] [Accepted: 07/20/2021] [Indexed: 02/02/2023] Open
Abstract
Simple Summary According to the 2020 World Health Organization classification, a giant cell tumor of bone is an intermediate malignant bone tumor. Denosumab treatment before curettage should be avoided due to the increased risk of local recurrence. Administration of denosumab before en bloc resection of the giant cell tumors of the pelvis and spine facilitates en bloc resection. Nerve-sparing surgery after embolization is a possible treatment for giant cell tumors of the sacrum. Denosumab therapy with or without embolization is indicated for inoperable giant cell tumors of the pelvis, spine, and sacrum. A wait-and-see approach is recommended for lung metastases at first, then denosumab should be administered to the growing lesions. Radiotherapy is not recommended owing to the risk of malignant transformation. Local recurrence after 2 years or more should be indicative of malignant transformation. This review summarizes the treatment approaches for non-malignant and malignant giant cell tumors of bone. Abstract The 2020 World Health Organization classification defined giant cell tumors of bone (GCTBs) as intermediate malignant tumors. Since the mutated H3F3A was found to be a specific marker for GCTB, it has become very useful in diagnosing GCTB. Curettage is the most common treatment for GCTBs. Preoperative administration of denosumab makes curettage difficult and increases the risk of local recurrence. Curettage is recommended to achieve good functional outcomes, even for local recurrence. For pathological fractures, joints should be preserved as much as possible and curettage should be attempted. Preoperative administration of denosumab for pelvic and spinal GCTBs reduces extraosseous lesions, hardens the tumor, and facilitates en bloc resection. Nerve-sparing surgery after embolization is a possible treatment for sacral GCTBS. Denosumab therapy with or without embolization is indicated for inoperable pelvic, spinal, and sacral GCTBs. It is recommended to first observe lung metastases, then administer denosumab for growing lesions. Radiotherapy is associated with a risk of malignant transformation and should be limited to cases where surgery is impossible and denosumab, zoledronic acid, or embolization is not available. Local recurrence after 2 years or more should be indicative of malignant transformation. This review summarizes the treatment approaches for non-malignant and malignant GCTBs.
Collapse
|
18
|
Singh VA, Puri A. The current standing on the use of denosumab in giant cell tumour of the bone. J Orthop Surg (Hong Kong) 2021; 28:2309499020979750. [PMID: 33331233 DOI: 10.1177/2309499020979750] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Giant cell tumour of the bone (GCTB) has been classically treated surgically. With the advent of denosumab, there is potential to use it as a targeted therapy to downstage the tumour and control its progression. Like all new therapies, the dosage, duration, and long-term effects of treatment can only be determined over the time through numerous trials and errors. The current recommendation of use of the monoclonal antibody is 3-4 months of neoadjuvant denosumab in patients with advanced GCTB for cases who were not candidates for primary curettage initially, and prolonged use for surgically unsalvageable GCTB. The use of Denosumab in the adjuvant setting to prevent recurrence is not established.
Collapse
Affiliation(s)
- Vivek Ajit Singh
- National Orthopaedic Centre of Excellence in Research & Learning (NOCERAL), Department of Orthopaedic Surgery, Faculty of Medicine, University Malaya, Kuala Lumpur, Malaysia
| | - Ajay Puri
- Tata Memorial Centre, Mumbai, Maharashtra, India
| |
Collapse
|
19
|
Immunohistochemical Characterization of Giant Cell Tumor of Bone Treated With Denosumab: Support for Osteoblastic Differentiation. Am J Surg Pathol 2021; 45:93-100. [PMID: 32773532 DOI: 10.1097/pas.0000000000001555] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Giant cell tumor of bone is a locally aggressive, rarely metastasizing neoplasm. Evidence suggests that the neoplastic cells may be osteoblastic in differentiation. Standard treatment is surgical removal, but medical therapy with denosumab, an inhibitor of receptor activator of nuclear factor-κβ ligand, has become a component of patient management in select cases. Denosumab-treated giant cell tumor of bone (DT-GCTB) shows drastic morphologic changes including the presence of abundant bone. To further determine the relationship of the neoplastic cells to osteoblast phenotype, we performed a morphologic and immunohistochemical study on a series of DT-GCTB. Cases of DT-GCTB were retrieved from surgical pathology files, available slides were reviewed, and immunohistochemistry for H3.3 G34W, SATB2, and p63 was performed. The cohort included 31 tumors from 30 patients (2:3 male:female), ages 15 to 73 years (median=36 y). The morphology of post-denosumab-treated tumors ranged from tumors composed of an abundant bone matrix with few spindle cells to spindle cell-predominant tumors. Five had focal residual classic CGTB, and 2 manifested mild nuclear atypia. The majority expressed all markers: 86.2% for H3.3 G34W, 96.7% for SATB2, and 100% for p63. All markers stained the various tumor components including spindle cells and the cells on the surface of and within the treated tumor bone matrix. Most markers were also positive in reactive-appearing woven bone adjacent to tumor: 84.6% for H3.3 G34W, 100% for SATB2, and 68% for p63. These findings suggest that denosumab treatment of giant cell tumor of bone results in osteoblastic differentiation with bone production.
Collapse
|
20
|
Perrin DL, Visgauss JD, Wilson DA, Griffin AM, Abdul Razak AR, Ferguson PC, Wunder JS. The role of Denosumab in joint preservation for patients with giant cell tumour of bone. Bone Joint J 2021; 103-B:184-191. [PMID: 33380180 DOI: 10.1302/0301-620x.103b1.bjj-2020-0274.r1] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS Local recurrence remains a challenging and common problem following curettage and joint-sparing surgery for giant cell tumour of bone (GCTB). We previously reported a 15% local recurrence rate at a median follow-up of 30 months in 20 patients with high-risk GCTB treated with neoadjuvant Denosumab. The aim of this study was to determine if this initial favourable outcome following the use of Denosumab was maintained with longer follow-up. METHODS Patients with GCTB of the limb considered high-risk for unsuccessful joint salvage, due to minimal periarticular and subchondral bone, large soft tissue mass, or pathological fracture, were treated with Denosumab followed by extended intralesional curettage with the goal of preserving the joint surface. Patients were followed for local recurrence, metastasis, and secondary sarcoma. RESULTS A total of 25 patients with a mean age of 33.8 years (18 to 67) with high-risk GCTB received median six cycles of Denosumab before surgery. Tumours occurred most commonly around the knee (17/25, 68%). The median follow-up was 57 months (interquartile range (IQR) 13 to 88). The joint was salvaged in 23 patients (92%). Two required knee arthroplasty due to intra-articular fracture and arthritis. Local recurrence developed in 11 patients (44%) at a mean of 32.5 months (3 to 75) following surgery, of whom four underwent repeat curettage and joint salvage. One patient developed secondary osteosarcoma and another benign GCT lung metastases. CONCLUSION The use of Denosumab for joint salvage was associated with a higher than expected rate of local recurrence at 44%. Neoadjuvant Denosumab for joint-sparing procedures should be considered with caution in light of these results. Cite this article: Bone Joint J 2021;103-B(1):184-191.
Collapse
Affiliation(s)
- David Louis Perrin
- Section of Orthopaedic Surgery, Department of Surgery, University of Manitoba, Winnipeg, Canada
| | - Julia D Visgauss
- Department of Orthopedic Surgery, Duke University Medical Center, Duke University, Durham, North Carolina, USA
| | - David A Wilson
- Division of Orthopaedic Surgery, Department of Surgery, Juravinski Cancer Centre, McMaster University, Hamilton, Canada
| | - Anthony M Griffin
- University Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Albiruni R Abdul Razak
- Department of Medical Oncology and Hematology, Princess Margaret Cancer Centre, University of Toronto, Toronto, Canada
| | - Peter C Ferguson
- University Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Jay S Wunder
- University Musculoskeletal Oncology Unit, Division of Orthopaedic Surgery, Department of Surgery, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|
21
|
Wang L, Fang D, Xu J, Luo R. Various pathways of zoledronic acid against osteoclasts and bone cancer metastasis: a brief review. BMC Cancer 2020; 20:1059. [PMID: 33143662 PMCID: PMC7607850 DOI: 10.1186/s12885-020-07568-9] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 10/26/2020] [Indexed: 12/19/2022] Open
Abstract
Zoledronic acid (ZA) is one of the most important and effective class of anti-resorptive drug available among bisphosphonate (BP), which could effectively reduce the risk of skeletal-related events, and lead to a treatment paradigm for patients with skeletal involvement from advanced cancers. However, the exact molecular mechanisms of its anticancer effects have only recently been identified. In this review, we elaborate the detail mechanisms of ZA through inhibiting osteoclasts and cancer cells, which include the inhibition of differentiation of osteoclasts via suppressing receptor activator of nuclear factor κB ligand (RANKL)/receptor activator of nuclear factor κB (RANK) pathway, non-canonical Wnt/Ca2+/calmodulin dependent protein kinase II (CaMKII) pathway, and preventing of macrophage differentiation into osteoclasts, in addition, induction of apoptosis of osteoclasts through inhibiting farnesyl pyrophosphate synthase (FPPS)-mediated mevalonate pathway, and activation of reactive oxygen species (ROS)-induced pathway. Furthermore, ZA also inhibits cancer cells proliferation, viability, motility, invasion and angiogenesis; induces cancer cell apoptosis; reverts chemoresistance and stimulates immune response; and acts in synergy with other anti-cancer drugs. In addition, some new ways for delivering ZA against cancer is introduced. We hope this review will provide more information in support of future studies of ZA in the treatment of cancers and bone cancer metastasis.
Collapse
Affiliation(s)
- Lianwei Wang
- Department of General Surgery, Fuling Central Hospital of Chongqing City, Chongqing, China
| | - Dengyang Fang
- Department of General Surgery, Fuling Central Hospital of Chongqing City, Chongqing, China
| | - Jinming Xu
- Department of General Surgery, Fuling Central Hospital of Chongqing City, Chongqing, China
| | - Runlan Luo
- Department of Ultrasound, Fuling Central Hospital of Chongqing City, Chongqing, 408300, China.
| |
Collapse
|
22
|
Li H, Gao J, Gao Y, Lin N, Zheng M, Ye Z. Denosumab in Giant Cell Tumor of Bone: Current Status and Pitfalls. Front Oncol 2020; 10:580605. [PMID: 33123484 PMCID: PMC7567019 DOI: 10.3389/fonc.2020.580605] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 08/28/2020] [Indexed: 12/14/2022] Open
Abstract
Denosumab is a monoclonal antibody against RANK ligand for treatment of giant cell tumor of bone (GCTB). Clinical trials and case series have demonstrated that denosumab is relevant to beneficial tumor response and surgical down-staging in patients of GCTB. However, these trials or case series have limitations with a short follow-up. Recent increasing studies revealed that denosumab probably increased the local recurrence risk in patients treated with curettage. This may be caused by the thicken bone margin of tumor that trapped tumor cells from curettage. The direct bone formation by tumor cells in the margin after denosumab treatment also contributed to the local recurrence. in vitro studies showed denosumab resulted in a cytostatic instead of a true cytotoxic response on neoplastic stromal cells. More importantly, denosumab-treated GCTB exhibited morphologic overlap with malignancy, and a growing number of patients of malignant transformation of GCTB during denosumab treatment have been reported. The optimal duration, long term safety, maintenance dose, and optimum indications remain to be elucidated. With these concerns in mind, this review warns that the denosumab therapy of GCTB should be applied with caution.
Collapse
Affiliation(s)
- Hengyuan Li
- Department of Orthopedics, Centre for Orthopedic Research, School of Medicine, Orthopedics Research Institute, Second Affiliated Hospital, Zhejiang University, Hangzhou, China.,Centre for Orthopaedic Research, School of Surgery, The University of Western Australia, Nedlands, WA, Australia
| | - Junjie Gao
- Centre for Orthopaedic Research, School of Surgery, The University of Western Australia, Nedlands, WA, Australia.,Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Youshui Gao
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Nong Lin
- Department of Orthopedics, Centre for Orthopedic Research, School of Medicine, Orthopedics Research Institute, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Minghao Zheng
- Centre for Orthopaedic Research, School of Surgery, The University of Western Australia, Nedlands, WA, Australia
| | - Zhaoming Ye
- Department of Orthopedics, Centre for Orthopedic Research, School of Medicine, Orthopedics Research Institute, Second Affiliated Hospital, Zhejiang University, Hangzhou, China
| |
Collapse
|
23
|
Can Denosumab be used in combination with Doxorubicin in Osteosarcoma? Oncotarget 2020; 11:2763-2773. [PMID: 32733647 PMCID: PMC7367655 DOI: 10.18632/oncotarget.27669] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 06/20/2020] [Indexed: 11/25/2022] Open
Abstract
Osteosarcoma is an aggressive bone tumor of the pediatric age. It is therefore important to improve conventional therapies (chemotherapy and surgery). Anticancer drugs often cause osteoporosis due to a misbalance of RANK/RANK-L/OPG pathway. Denosumab is a monoclonal antibody with high affinity and specificity to RANK-L, the ligand released by osteoblasts that enhances osteoclasts differentiation and bone resorption. It is used in osteoporosis and in other conditions characterized by bone mass loss. Doxorubicin is a chemotherapic drug used in several kinds of tumors, and also patients treated with it often develop osteoporosis. We investigated the effects of Denosumab alone and in combination with Doxorubicin, in two human osteosarcoma cell lines (MG63 and U-2 OS). We evaluated the effect of these treatments on apoptosis, cell cycle progression, invasion capacity and bone metabolism. We observed for the first time an anti-invasive effect of Denosumab in OS cells and confirmed its anti-osteoporotic activity also in Osteosarcoma. On the other hand, we demonstrate that Denosumab not only does not affect apoptosis and cell cycle progression, but when used in combination with Doxorubicin, it causes an unexpected reduction of its activity. These results indicate that the presence of Denosumab might inhibit the efficacy of the chemotherapic drug. In conclusion, while our results certainly support and confirm the efficacy of Denosumab in Osteoporosis, we discourage the use of Denosumab in addition to conventional chemotherapy in Osteosarcoma, even though, certainly further investigations are necessary to better clarify the clinical role of this monoclonal antibody in cancer.
Collapse
|
24
|
War AR, Dang K, Jiang S, Xiao Z, Miao Z, Yang T, Li Y, Qian A. Role of cancer stem cells in the development of giant cell tumor of bone. Cancer Cell Int 2020; 20:135. [PMID: 32351329 PMCID: PMC7183664 DOI: 10.1186/s12935-020-01218-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2019] [Accepted: 04/17/2020] [Indexed: 02/06/2023] Open
Abstract
The primary bone tumor is usually observed in adolescence age group which has been shown to be part of nearly 20% of the sarcomas known today. Giant cell tumor of bone (GCTB) can be benign as well as malignant tumor which exhibits localized dynamism and is usually associated with the end point of a long bone. Giant cell tumor (GCT) involves mononuclear stromal cells which proliferate at a high rate, multinucleated giant cells and stromal cells are equally present in this type of tumor. Cancer stem cells (CSCs) have been confirmed to play a potential role in the development of GCT. Cancer stem cell-based microRNAs have been shown to contribute to a greater extent in giant cell tumor of bone. CSCs and microRNAs present in the tumors specifically are a great concern today which need in-depth knowledge as well as advanced techniques to treat the bone cancer effectively. In this review, we attempted to summarize the role played by cancer stem cells involving certain important molecules/factors such as; Mesenchymal Stem Cells (MSCs), miRNAs and signaling mechanism such as; mTOR/PI3K-AKT, towards the formation of giant cell tumor of bone, in order to get an insight regarding various effective strategies and research advancements to obtain adequate knowledge related to CSCs which may help to focus on highly effective treatment procedures for bone tumors.
Collapse
Affiliation(s)
- Abdul Rouf War
- 1Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072 Shaanxi China.,2Research Center for Special Medicine and Health Systems Engineering, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072 Shaanxi China.,3NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072 Shaanxi China
| | - Kai Dang
- 1Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072 Shaanxi China.,2Research Center for Special Medicine and Health Systems Engineering, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072 Shaanxi China.,3NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072 Shaanxi China
| | - Shanfen Jiang
- 1Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072 Shaanxi China.,2Research Center for Special Medicine and Health Systems Engineering, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072 Shaanxi China.,3NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072 Shaanxi China
| | - Zhongwei Xiao
- 4Department of Neurology, Shanghai Pudong Hospital, Fudan University, Shanghai, 201399 People's Republic of China
| | - Zhiping Miao
- 1Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072 Shaanxi China.,2Research Center for Special Medicine and Health Systems Engineering, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072 Shaanxi China.,3NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072 Shaanxi China
| | - Tuanmin Yang
- 5Honghui Hospital, Xi'an, Jiaotong University College of Medicine, Xi'an, Shaanxi China
| | - Yu Li
- 1Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072 Shaanxi China.,2Research Center for Special Medicine and Health Systems Engineering, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072 Shaanxi China.,3NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072 Shaanxi China
| | - Airong Qian
- 1Laboratory for Bone Metabolism, Key Laboratory for Space Bioscience and Biotechnology, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072 Shaanxi China.,2Research Center for Special Medicine and Health Systems Engineering, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072 Shaanxi China.,3NPU-UAB Joint Laboratory for Bone Metabolism, School of Life Sciences, Northwestern Polytechnical University, Xi'an, 710072 Shaanxi China
| |
Collapse
|
25
|
Abstract
Purpose of review Giant cell tumor of bone (GCTB) is an uncommon benign primary bone tumor, consisting of receptor activator of nuclear factor kappa-B (RANK) expressing reactive osteoclast-like giant cells and neoplastic spindle-shaped cells. Denosumab was approved by FDA in 2013 and by EMA in 2014 to treat adults and skeletally mature adolescents with unresectable GCTB or when resection is likely to result in severe morbidity. However, there is much discussion regarding the optimal applied treatment strategy. Recent findings Neoadjuvant treatment of GCTB with denosumab can effectively downstage tumors to facilitate less morbid surgery or completely avoid the need for resection, but there is concern about local recurrence postsurgery. Definitive treatment of unresectable GTCB improves symptoms and halts tumor progression. The optimal treatment duration is unclear and long-term treatment is associated with adverse events like osteonecrosis of the jaw (ONJ) and atypical femoral fractures. Denosumab maintenance dose interval is currently being investigated. Summary For the related but heterogenous group of giant cell rich tumors of bone, like aneurysmal bone cysts (ABC) and central giant cell granuloma (CGCG), denosumab is a new treatment modality under investigation. Given the effectiveness in GCTB, this could be a promising treatment option for selected patients with advanced disease.
Collapse
|
26
|
Lipplaa A, Kroep JR, van der Heijden L, Jutte PC, Hogendoorn PCW, Dijkstra S, Gelderblom H. Adjuvant Zoledronic Acid in High-Risk Giant Cell Tumor of Bone: A Multicenter Randomized Phase II Trial. Oncologist 2019; 24:889-e421. [PMID: 31040253 PMCID: PMC6656477 DOI: 10.1634/theoncologist.2019-0280] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 04/06/2019] [Indexed: 11/17/2022] Open
Abstract
Lessons Learned. Adjuvant treatment with zoledronic acid did not decrease the recurrence rate of giant cell tumor of bone (GCTB) in this study. The efficacy could not be determined because of the small sample size. GCTB recurrences, even in the denosumab era, are still an issue; therefore, a randomized study exploring the efficacy of zoledronic acid in the adjuvant setting in GCTB is still valid.
Background. Bisphosphonates are assumed to inhibit giant cell tumor of bone (GCTB)‐associated osteoclast activity and have an apoptotic effect on the neoplastic mononuclear cell population. The primary objective of this study was to determine the 2‐year recurrence rate of high‐risk GCTB after adjuvant zoledronic acid versus standard care. Methods. In this multicenter randomized open‐label phase II trial, patients with high‐risk GCTB were included (December 2008 to October 2013). Recruitment was stopped because of low accrual after the introduction of denosumab. In the intervention group, patients received adjuvant zoledronic acid (4 mg) intravenously at 1, 2, 3, 6, 9, and 12 months after surgery. Results. Fourteen patients were included (intervention n = 8, controls n = 6). Median follow‐up was long: 93.5 months (range, 48–111). Overall 2‐year recurrence rate was 38% (3/8) in the intervention versus 17% (1/6) in the control group (p = .58). All recurrences were seen within the first 15 months after surgery. Conclusion. Adjuvant treatment with zoledronic acid did not decrease the recurrence rate of GCTB in this study. The efficacy could not be determined because of the small sample size. Because recurrences, even in the denosumab era, are still an issue, a randomized study exploring the efficacy of zoledronic acid in the adjuvant setting in GCTB is still valid.
Collapse
Affiliation(s)
- Astrid Lipplaa
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Judith R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lizz van der Heijden
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Paul C Jutte
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Sander Dijkstra
- Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Hans Gelderblom
- Department of Medical Oncology, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
27
|
Li S, Chen P, Yang Q. Denosumab versus zoledronic acid in cases of surgically unsalvageable giant cell tumor of bone: A randomized clinical trial. J Bone Oncol 2019; 15:100217. [PMID: 30740297 PMCID: PMC6357891 DOI: 10.1016/j.jbo.2019.100217] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Revised: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Although denosumab has been approved as an antiresorptive agent for giant cell tumor of bone, its efficacy has not been proven. OBJECTIVES To compare the efficacy and safety of denosumab and zoledronic acid treatment in patients with surgically unsalvageable giant cell tumor of bone. METHODS A total of 250 patients with surgically unsalvageable giant cell tumor of bone were included in this randomized clinical trial. Patients received either subcutaneous denosumab (DB group; 120 mg per 4 weeks plus an additional 120 mg on days 8 and 15; n = 125) or intravenous zoledronic acid (ZA group; 4 mg per 4 weeks; n = 125) for six cycles. Disease status, clinical benefits, treatment-emergent adverse effects, overall survival, and cost of treatment were evaluated during the follow-up period. Statistical significance was determined using 95% confidence intervals. RESULTS Denosumab and zoledronic acid had similar tumor responses (p = 0.18) and clinical benefits (p = 0.476). Disease progression was observed in fewer patients in the DB group (1%) than ZA group (2%). Denosumab caused fatigue (p = 0.0004) and back pain (p < 0.0001), while zoledronic acid caused hypocalcemia (p < 0.0001), flu-like symptoms (p = 0.021), hypotension (p = 0.021), and hypokalemia (p = 0.021). Denosumab treatment was markedly more expensive than zoledronic acid treatment (p < 0.0001). The cost to manage treatment-emergent adverse effects was higher for the ZA group than the DB group (p = 0.0425). Overall survival was the same for both treatments (p = 0.066). CONCLUSIONS Denosumab is a safe but costly alternative to zoledronic acid for treatment of surgically unsalvageable giant cell tumor of bone.
Collapse
Key Words
- ALT test, Alanine aminotransferase test
- ANOVA, analysis of variance
- AST test, Aspartate aminotransferase test
- Antiresorptive
- Bone density conservation agents
- CONSORT, Consolidated standards of reporting trials
- CT, the computed tomography
- CTCAE, Common Terminology Criteria for Adverse Events
- Denosumab
- EMA, the European Medicines Agency
- EORTC, European organization for research and treatment of cancer
- GCTB, giant cell tumor of bone
- Giant cell tumor of bone
- MRI, magnetic resonance imaging
- N, sample population
- RANKL, Receptor activator of nuclear factor kappa-Β ligand
- RECIST, response evaluation criteria in solid tumors
- US FDA, the United States Food and Drug Administration
- Zoledronic acid
- n, sample size
Collapse
Affiliation(s)
- Shenglong Li
- Department of Bone and Soft Tissue Tumor Surgery, Cancer Hospital of China Medical University, Liaoning Cancer Hospital & Institute, No 44 of Xiaoheyan Road, Dadong District, Shenyang, Liaoning Province 110042, China
| | | | | |
Collapse
|
28
|
Shi M, Chen L, Wang Y, Wang W, Zhang Y, Yan S. Effect of bisphosphonates on local recurrence of giant cell tumor of bone: a meta-analysis. Cancer Manag Res 2019; 11:669-680. [PMID: 30666162 PMCID: PMC6331072 DOI: 10.2147/cmar.s187316] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background Giant cell tumor of bone (GCTB) is a locally aggressive tumor, and its postoperative recurrence remains a problem. The present meta-analysis aimed to analyze the effect of bisphosphonates (BPs) on local recurrence of GCTB. Methods Seven case-control studies were included by computerized searches of bibliographic databases (PubMed, AMED, EMBASE, the Cochrane library, ISI Web of Science, and China National Knowledge Infrastructure). The pooled adjusted ORs were calculated to evaluate the local recurrence of GCTB. Results The BP group presented significantly lower total local recurrence rate than the control group in GCTB (P<0.01). Subgroup analysis shows BP group presented significantly lower local recurrence than the control group in GCTB with different tumor grades (P<0.05). In patients who underwent intralesional curettage, a significantly lower local recurrence rate was found in the BP group compared with the control group (P<0.01), but no significance was found for patients who underwent wide resection (P=0.16). None of the included studies described severe adverse effects related to BPs. Conclusion The results confirmed the effect of BPs on reducing the local recurrence of GCTB, and the effect is not influenced by the tumor grades. BPs are benefit for the patients who underwent intralesional curettage but not recommended for those who underwent wide resection.
Collapse
Affiliation(s)
- Mingmin Shi
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China,
| | - Lei Chen
- Department of Endocrinology and Metabolism, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China
| | - Yangxin Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China,
| | - Wei Wang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China,
| | - Yujie Zhang
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China,
| | - Shigui Yan
- Department of Orthopaedic Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China,
| |
Collapse
|
29
|
Yu C, Wang L, Ni Y, Wang J. A simple and robust reporter gene assay for measuring the bioactivity of anti-RANKL therapeutic antibodies. RSC Adv 2019; 9:40196-40202. [PMID: 35542634 PMCID: PMC9076180 DOI: 10.1039/c9ra07328k] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 11/16/2019] [Indexed: 11/21/2022] Open
Abstract
The mechanism sketch of the reporter gene assay for the bioactivity determination of anti-RANKL mAbs.
Collapse
Affiliation(s)
- Chuanfei Yu
- Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products
- National Institutes for Food and Drug Control
- Beijing
- China
| | - Lan Wang
- Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products
- National Institutes for Food and Drug Control
- Beijing
- China
| | - Yongbo Ni
- Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products
- National Institutes for Food and Drug Control
- Beijing
- China
| | - Junzhi Wang
- Key Laboratory of the Ministry of Health for Research on Quality and Standardization of Biotech Products
- National Institutes for Food and Drug Control
- Beijing
- China
| |
Collapse
|