Denosumab: what we know and what we don’t X-ref
Denosumab was touted as the cure-all drug for giant cell tumours (GCT) and fast-tracked by regulators given its impressive early results. It is a monoclonal antibody to the RANK-Ligand, a key step in cell-to-cell mediation between osteoclasts and osteoblasts, resulting in bone resorption. This pathway has been implicated in oncological osteolysis and also in aseptic loosening. Denosumab is particularly effective against GCT of bone and has been shown to be clinically useful to downstage tumours with a large soft-tissue extension which can allow for less morbid surgery. The role of denosumab in conventional limb GCT of bone is, however, yet to be defined. This review from various centres1 highlights the current strengths in the literature, and what is and isn’t known about denosumab use. The recurrence rates when therapy is stopped, along with the concerns over long-term use and unclear clinical toxicity, are clearly and succinctly reviewed. A must-read for any clinician treating bone sarcomas or those involved in the long-term aftercare of these patients.
Patient or clinician functional results?
In a very interesting article that piqued our interest, here at 360, surgeons in Boston, Massachusetts (USA)2 have reported the outcomes of tumour surgery, from both the patient and the clinician perspectives. The current vogue is to report patient-reported outcomes for healthcare interventions, however, there are some concerns that these outcome measures are ‘contaminated’. There has been research to suggest that extrinsic factors such as ease of parking, quality of hospital food and others are specifically associated with the reporting of outcome scores. In an interesting and cunningly designed study, these surgeons set out to establish if there is a difference between patient- and clinician-reported functional outcomes using the MSTS score. They report the outcomes of 128 patients, all presenting with bone metastasis of the lower limb. The authors report patient and …