Giant Cell Tumor (Osteoclastoma): Drug Therapy

Therapeutic targets

• Relief of pain
• Stabilization of bone sections at risk of fracture
• Removal of the tumor – see “Surgical Therapy“.
• Healing

Therapy recommendations

• Analgesia according to WHO staging scheme:
  • Non-opioid analgesic (paracetamol, first-line agent).
  • Low-potency opioid analgesic (e.g., tramadol) + non-opioid analgesic.
  • High-potency opioid analgesic (eg, morphine) + non-opioid analgesic.
• Denosumab, a monoclonal antibody, is used to treat a giant cell tumor of the bone (osteoclastoma):
  • Mode of action Denosumab: antiresorptive by binding to RANK ligand → inhibition of osteoclast activity → decrease in bone resorption and increase in bone mass and strength.
  • Contraindications:
    • Patients who have unhealed lesions from dental surgery or oral surgery.
    • A patient reminder card is introduced to increase patient awareness of the risk of osteonecrosis of the jaw and the precautions needed to minimize it.
    • Patients treated with denosumab must be given the patient reminder card with information about osteonecrosis of the jaw and the package insert.
  • Side effects: Limb, muscle and skeletal pain, risk of osteonecrosis of the jaw and hypocalcemia.
  • Caveat:
    • Osteonecrosis of the jaw bone and external auditory canal during therapy with bisphosphonates and denosumab.
    • In clinical trials in patients with advanced cancers, occurrence of increased incidence of new primary malignancies with denosumab compared with zoledronic acid.
• Often, after surgical removal of the giant cell tumor to kill possible remaining tumor cells, chemical toxic substances such as phenol are instilled (dropwise administration into the affected area).