The dilemma of denosumab: Salvage of a femoral head giant cell tumour

INTRODUCTION: Denosumab is a monoclonal RANKL antibody which has been shown to be highly effective in treating giant cell tumour (GCT) of bone. We report on its use as a neo-adjuvant agent to avoid morbid surgery for an adolescent. PRESENTATION OF CASE: We report a case of a15-year old female with a Campanacci 3 GCT involving the femoral head and neck. DISCUSSION: To preserve bone stock and avoid an outright hip replacement, the patient was given denosumab pre-operatively to consolidate the tumour. After receiving 6 months of treatment, a rim of cortical bone had developed to allow an extended curettage of the tumour to be performed without fear of collapse of the articular surface. CONCLUSION: This is the first reported case of the use of denosumab in GCT of the femoral head and neck. We describe our experience in the neo-adjuvant use of denosumab and offer suggestions for future use. Further studies will be needed to see if denosumab has a role in conventional GCT and whether it can lead to a lowering of local recurrence rates.