# A Multicenter Study by the DENO Research Group on the Use of Denosumab in Giant-Cell Tumors of the Bone

## TL;DR

This study examines how denosumab is used to treat giant-cell tumors of the bone across different treatment strategies and finds similar recurrence rates between approaches.

## Contribution

The study provides real-world data on denosumab treatment protocols for GCTB and compares recurrence rates across different strategies.

## Key findings

- Recurrence rates were similar between neoadjuvant and adjuvant treatment strategies.
- Discontinuation of single denosumab treatment did not necessarily lead to disease progression.
- Over 85% of patients reported favorable clinical outcomes with denosumab.

## Abstract

Background/Objectives: Despite the therapeutic potential of denosumab for the treatment of giant-cell tumors of the bone (GCTBs), there is a lack of standardization in treatment protocols. Methods: We present a multicenter, retrospective, descriptive study conducted across the seven hospitals in Spain affiliated with the DENO Research Group. Seventy-three patients diagnosed with GCTB and treated with denosumab were included and stratified according to treatment strategy—neoadjuvant (n = 38), adjuvant (n = 8), and single treatment (n = 27). Results: Patients in the neoadjuvant group received denosumab for a median of 6.1 months, with reintroduction after surgery in 25.8% of all cases. Among the neoadjuvant patients treated with curettage, recurrence was 35.5%, with no association with denosumab treatment duration (p = 0.274) nor with denosumab reintroduction after surgery (p = 0.405). In the adjuvant group, those who completed treatment received denosumab for 15.3 months, while those still undergoing therapy received it for a median of 12.8 months; only one case (12.5%) recurred. Recurrence rates in neoadjuvant and adjuvant treatment strategies were not different (p = 0.394). Patients treated only with denosumab and no longer on treatment had received it for 34.2 months, with 31.3% recurrence; those still on treatment had received it for 51.8 months, with 25.0% recurrence. Across all strategies, more than 85% of patients reported favorable clinical outcomes, and only 43.8% presented adverse events. No deaths occurred during this study. Conclusions: Although patients who experienced recurrence during neoadjuvant treatment had longer durations of denosumab administration, the difference was not statistically significant. Similarly, recurrence rates did not differ significantly, whether denosumab was reintroduced after surgery or not. Among the patients treated with curettage, recurrence rates were comparable between neoadjuvant and adjuvant strategies. Discontinuation of the single treatment did not necessarily result in disease progression.