Giant cell tumor (GCT) of bone at the distal radius recurs locally 2 years after curettage and bone grafting. The Campanacci grade was III (cortical destruction with soft tissue extension). Which drug can be used as neoadjuvant/adjuvant therapy to reduce the size of the tumor and lower the risk of recurrence?
- A Methotrexate
- B Denosumab ✓
- C Zoledronic acid
- D Interferon-alpha
Correct answer: B. Denosumab
Explanation
Denosumab, a RANK-L inhibitor, has become the standard adjuvant/neoadjuvant agent for GCT of bone. GCT stromal cells overexpress RANK-L, which drives osteoclast activation (the multinucleated giant cells are reactive osteoclast-like cells). Denosumab causes tumor necrosis, bone reformation, and significant size reduction, facilitating limb salvage surgery for Campanacci III lesions. Interferon-alpha (D) was historically used for pulmonary metastases of GCT but is now largely replaced by denosumab.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.