Meta-Analysis
Copyright ©The Author(s) 2025. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Orthop. Mar 18, 2025; 16(3): 102520
Published online Mar 18, 2025. doi: 10.5312/wjo.v16.i3.102520
Denosumab regimens in the treatment of giant cell tumor of bone: A systematic review with meta-analysis
Bruno G Barreto, Claudio Santili, Alex Guedes, Fernando D Moreira, Claudio Luiz DSL Paz
Bruno G Barreto, Department of Orthopedics and Traumatology, Hospital Aristides Maltez, Salvador 40285-001, Bahia, Brazil
Bruno G Barreto, Alex Guedes, Fernando D Moreira, Department of Orthopedics and Traumatology, Hospital Santa Izabel, Salvador 40050-410, Bahia, Brazil
Claudio Santili, Department of Orthopedics and Traumatology, Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo 01221-020, São Paulo, Brazil
Alex Guedes, Department of Orthopedics and Traumatology Medical Residency Program, Professor Edgard Santos University Hospital Complex, Brazilian Hospital Services Enterprise, Federal University of Bahia, Salvador 40110-060, Bahia, Brazil
Alex Guedes, Department of Orthopedics and Traumatology, Hospital Aristides Maltez, Salvador 400285-001, Bahia, Brazil
Claudio Luiz DSL Paz, Instituto de Ciências da Saúde, Universidade Federal da Bahia, Salvador 40000-000, Bahia, Brazil
Co-corresponding authors: Bruno G Barreto and Alex Guedes.
Author contributions: Barreto BG contributed to the design and conception of the study and the writing of the manuscript; Moreira FD and Paz CLD contributed to acquisition of data and statistical analyses; Barreto BG and Guedes A contributed to the performance and quality of the research; Guedes A and Santili C contributed to final revision and the writing of the manuscript.
Conflict-of-interest statement: All the authors have no financial or non-financial interests to disclose.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Bruno G Barreto, MD, Professor, Department of Orthopedics and Traumatology, Hospital Aristides Maltez, av. Dom João VI 332, Salvador 40285-001, Bahia, Brazil. bbarreto1978@gmail.com
Received: October 21, 2024
Revised: January 6, 2025
Accepted: February 12, 2025
Published online: March 18, 2025
Processing time: 142 Days and 16.7 Hours
Abstract
BACKGROUND

Giant cell tumor of bone (GCTB) is a rare, locally aggressive neoplasm that should be treated surgically, whenever possible. This treatment approach may be linked with greater morbidity besides functional impairment. Denosumab is a human monoclonal antibody. Its administration inhibits bone resorption and has become part of the therapeutic armamentarium against GCTB, as it allows local control with a view to downstaging for a more conservative surgical procedure. However, there is no consensus in the literature regarding the optimal denosumab regimen for GCTB. Therefore, a wide discussion of denosumab regimen is necessary.

AIM

To assess the effectiveness of various therapy protocols employing denosumab in individuals with GCTB.

METHODS

A broad and systematic literature search was carried out using the PRISMA guidelines. We analyzed studies that reported skeletally mature patients with GCTB regardless of sex or ethnicity treated with denosumab. Articles with fewer than five patients and in languages except Spanish, Portuguese and English were excluded. Statistical analysis with proportion meta-analysis was performed due to the dichotomous nature of the data.

RESULTS

1005 articles were screened, of which 26 articles met the inclusion criteria and were selected, totaling 1742 patients, 51.8% women and 48.2% men, with an average of 35 years of age. Treatment with denosumab was associated with high rates of clinical benefit (CB) and imaging response (IR), without changing local recurrence rates when compared to patients treated without denosumab, regardless of the therapeutic regimen adopted and the number of doses applied. The adverse events (AE) presented were mostly mild, with the exception of a malignant transformation to osteosarcoma.

CONCLUSION

Treatment of GCTB with denosumab is effective, showing high rates of CB and IR. The AE that occurred were mostly mild. We found no differences between the articles considering the researched outcomes regardless of the therapeutic regimen adopted.

Keywords: Bone neoplasms; Denosumab; Outcome assessment health care; Giant cell tumor of bone; Systematic review

Core Tip: This systematic review with meta-analysis of proportions sought to evaluate the effectiveness of various denosumab-containing therapeutic regimens in the treatment of giant cell tumor of bone in terms of clinical outcomes, imaging response (IR), local recurrence (LR), and adverse events. Denosumab proved to be effective in inducing clinical response and IR, without impact on LR, regardless of the regimen and number of doses.