Updated concepts in treatment of giant cell tumor of bone.
Journal
Current opinion in oncology
ISSN: 1531-703X
Titre abrégé: Curr Opin Oncol
Pays: United States
ID NLM: 9007265
Informations de publication
Date de publication:
01 07 2022
01 07 2022
Historique:
entrez:
15
7
2022
pubmed:
16
7
2022
medline:
19
7
2022
Statut:
ppublish
Résumé
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. 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. 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.
Identifiants
pubmed: 35837707
doi: 10.1097/CCO.0000000000000852
pii: 00001622-202207000-00019
doi:
Substances chimiques
B7-H1 Antigen
0
Bone Cements
0
Bone Density Conservation Agents
0
Denosumab
4EQZ6YO2HI
Zoledronic Acid
6XC1PAD3KF
Types de publication
Journal Article
Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
371-378Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
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