Denosumab
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Osteonecrosis of the jaw : 2 case reports In a retrospective, single-institutional study of 29 patients with giant cell tumour of bone (GCTB) two patients, a 72-year-old woman and a 40-year-old man were described, who developed medication-related osteonecrosis of the jaw (MR-ONJ) during treatment with denosumab for GCTB. Case 1: A 72-year-old woman, who was diagnosed with a large GCTB in November 2010, started receiving SC denosumab 120mg injection every 4 weeks in March 2011 with additional loading doses on days 8 and 15 during the first cycle. Her GCTB subsequently improved. However, her treatment was discontinued after 41 months due to onset of stage 2 MR-ONJ, which was unresponsive to unspecified anti-inflammatory and antibiotic therapy. Therefore, she was treated with ozone therapy followed by a surgical toilette of the jaw bone. However, 9 months after denosumab discontinuation, she had disease progression. Thus, she was reinitiated on denosumab at a standard dose with reduction in tumour size. However, she developed stage 3 MR-ONJ at 39 months after denosumab initiation. Her denosumab was discontinued again, and she was treated with ozone therapy followed by surgical toilette of the mandibular bone resulting in complete resolution of MR-ONJ. Her GCTB was stable without denosumab for 8 months. Case 2: A 40-year-old man started receiving SC denosumab 120mg injection every 4 weeks with additional loading doses on days 8 and 15 during the first cycle. His GCTB improved after 2 months. After 6 years of denosumab initiation, he developed rapidly increasing oral inflammation and pain to the right part of his upper dental arch. He was treated with unspecified antibiotic and antiinflammatory agents with temporary relief. He was was diagnosed with stage 2 MR-ONJ of the maxillary bone. Thus, his denosumab was stopped, and he was treated with ozone therapy followed by a surgical partial resection of the affected maxillary bone. The necrotic area was removed up to the surrounding vital bone. After 11 months of denosumab discontinuation, his GCTB progressed. Therefore, denosumab was rechallenged with disease stabilisation. At last follow-up visit 25 months later, he had no relapse of MRONJ or any additional toxicity. Raimondi A, et al. Rechallenge of denosumab in jaw osteonecrosis of patients with unresectable giant cell tumour of bone: A case series analysis and literature review. ESMO 803497245 Open 5: No. 4, 12 Jul 2020. Available from: URL: http://doi.org/10.1136/esmoopen-2019-000663
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Reactions 22 Aug 2020 No. 1818
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