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El Masry AM, Azmy SI, Mustafa MAR, Abuelhadid MA. Using Denosumab as a Nonsurgical Management of Aneurysmal Bone Cysts in the Pelvis. Clin Orthop Surg 2024; 16:149-156. [PMID: 38304208 PMCID: PMC10825244 DOI: 10.4055/cios22228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 06/09/2023] [Accepted: 06/09/2023] [Indexed: 02/03/2024] Open
Abstract
Background Aneurysmal bone cysts (ABCs) are infrequent, benign, and locally destructive lesions that most commonly occur during the first two decades of life. They usually affect the metaphysis of the long bones, but the pelvis is involved in 8%-12% of the cases. The management of pelvic ABCs is a challenging issue due to difficulties in choosing the appropriate approach, adjacent neurovascular bundles, the risk of intraoperative bleeding with difficulty achieving good hemostasis, and the risk of injury to the hip or sacroiliac joints. Limited data exist concerning the use of denosumab as a non-surgical treatment for pelvic ABCs. Our hypothesis was that denosumab might be an effective and safe solo treatment of cases with ABCs in the pelvis. Methods We retrospectively assessed 20 patients with ABCs in the pelvis, who were treated by denosumab as a solo agent without surgery. Patients were assessed regarding disease control, the incidence of recurrence and non-oncological complications, and functional outcome. Results The mean follow-up period was 38.5 months. Disease control was achieved in 16 patients (80%), with no local recurrence. Tolerable drug-related complications occurred in 15% of cases. The mean Musculoskeletal Tumor Society score was 92.3%. Conclusions Denosumab may provide a reliable option in the nonsurgical treatment of ABCs of pelvic origin with expected lower morbidity than the surgical solution and tolerable complications. Further studies on the safety profile and long-term effects of denosumab especially in skeletally immature patients are required.
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Affiliation(s)
| | - Sherif Ishak Azmy
- Department of Orthopedic Surgery, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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2
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Delgado M, Garcia-Sanz JA. Therapeutic Monoclonal Antibodies against Cancer: Present and Future. Cells 2023; 12:2837. [PMID: 38132155 PMCID: PMC10741644 DOI: 10.3390/cells12242837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/06/2023] [Accepted: 12/12/2023] [Indexed: 12/23/2023] Open
Abstract
A series of monoclonal antibodies with therapeutic potential against cancer have been generated and developed. Ninety-one are currently used in the clinics, either alone or in combination with chemotherapeutic agents or other antibodies, including immune checkpoint antibodies. These advances helped to coin the term personalized medicine or precision medicine. However, it seems evident that in addition to the current work on the analysis of mechanisms to overcome drug resistance, the use of different classes of antibodies (IgA, IgE, or IgM) instead of IgG, the engineering of the Ig molecules to increase their half-life, the acquisition of additional effector functions, or the advantages associated with the use of agonistic antibodies, to allow a broad prospective usage of precision medicine successfully, a strategy change is required. Here, we discuss our view on how these strategic changes should be implemented and consider their pros and cons using therapeutic antibodies against cancer as a model. The same strategy can be applied to therapeutic antibodies against other diseases, such as infectious or autoimmune diseases.
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Affiliation(s)
| | - Jose A. Garcia-Sanz
- Department of Molecular Biomedicine, Centro de Investigaciones Biológicas Margarita Salas (CIB-CSIC), 28040 Madrid, Spain;
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Mahdal M, Tomáš T, Apostolopoulos V, Adámková D, Múdry P, Staniczková Zambo I, Pazourek L. Proximal Tibia Tumour Location and Curettage Are Major Risk Factors of Local Recurrence in Giant Cell Tumour of Bone. Cancers (Basel) 2023; 15:4664. [PMID: 37760632 PMCID: PMC10526787 DOI: 10.3390/cancers15184664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 09/29/2023] Open
Abstract
Giant cell tumour of bone (GCTB) is one of the most common local aggressive tumourous lesions with a wide variety of biological behaviour. However, there are no clear indicative criteria when choosing the type of procedure and the complication rates remain high, especially in terms of local recurrence. The purpose of the study was to (1) identify the main risk factors for local recurrence, (2) evaluate the recurrence-free survival in dependence on neoadjuvant denosumab use and the type of procedure, and (3) compare the functional outcomes after curettage and en bloc resection. The group included 102 patients with GCTB treated between 2006 and 2020. The mean age of patients was 34.4 years (15-79). The follow-up period was 8.32 years (2-16) on average. Local recurrence occurred in 14 patients (29.8%) who underwent curettage and in 5 patients (10.6%) after en bloc resection. Curettage was shown to be a factor in increasing recurrence rates (OR = 3.64 [95% CI: 1.19-11.15]; p = 0.023). Tibial location was an independent risk factor for local recurrence regardless of the type of surgery (OR = 3.22 [95% CI: 1.09-9.48]; p = 0.026). The recurrence-free survival rate of patients treated with resection and denosumab was higher compared to other treatments at five years postoperatively (p = 0.0307). Functional ability and pain as reported by patients at the latest follow-up were superior after curettage compared to resection for upper and lower extremity (mean difference: -4.00 [95% CI: -6.81 to -1.18]; p < 0.001 and mean difference: -5.36 [95% CI: -3.74 to -6.97]; p < 0.001, respectively). Proximal tibia tumour location and curettage were shown to be major risk factors for local recurrence in GCTB regardless of neoadjuvant denosumab treatment. The recurrence-free survival rate of patients treated with resection and denosumab was higher compared to other treatments. The functional outcome of patients after curettage was better compared to en bloc resection.
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Affiliation(s)
- Michal Mahdal
- First Department of Orthopaedic Surgery, St. Anne’s University Hospital, 60200 Brno, Czech Republic; (M.M.); (T.T.); (V.A.)
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic; (D.A.); (P.M.); (I.S.Z.)
| | - Tomáš Tomáš
- First Department of Orthopaedic Surgery, St. Anne’s University Hospital, 60200 Brno, Czech Republic; (M.M.); (T.T.); (V.A.)
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic; (D.A.); (P.M.); (I.S.Z.)
| | - Vasileios Apostolopoulos
- First Department of Orthopaedic Surgery, St. Anne’s University Hospital, 60200 Brno, Czech Republic; (M.M.); (T.T.); (V.A.)
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic; (D.A.); (P.M.); (I.S.Z.)
| | - Dagmar Adámková
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic; (D.A.); (P.M.); (I.S.Z.)
- Clinic of Comprehensive Cancer Care, Masaryk Memorial Cancer Institute, 60200 Brno, Czech Republic
| | - Peter Múdry
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic; (D.A.); (P.M.); (I.S.Z.)
- Department of Pediatric Oncology, University Hospital Brno, 66263 Brno, Czech Republic
| | - Iva Staniczková Zambo
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic; (D.A.); (P.M.); (I.S.Z.)
- First Department of Pathology, St. Anne’s University Hospital, 60200 Brno, Czech Republic
| | - Lukáš Pazourek
- First Department of Orthopaedic Surgery, St. Anne’s University Hospital, 60200 Brno, Czech Republic; (M.M.); (T.T.); (V.A.)
- Faculty of Medicine, Masaryk University, 62500 Brno, Czech Republic; (D.A.); (P.M.); (I.S.Z.)
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Jiang D, Wang J, Chen Q, Wu J, Xu M, Yu X. Comprehensive conservative treatment for multiple metastases of skull osteosarcoma: A case report. Front Neurol 2023; 14:1037673. [PMID: 36779058 PMCID: PMC9909182 DOI: 10.3389/fneur.2023.1037673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/11/2023] [Indexed: 01/27/2023] Open
Abstract
Background Skull osteosarcoma is relatively rare, and it is difficult to be diagnosed according to medical history and imaging examination due to the complex structure and diverse components of the brain. Consequently, there is only a limited number of patients who can undergo neoadjuvant chemotherapy before the operation. Although neoadjuvant chemotherapy plays an important role in the treatment of osteosarcoma, there is still a "bottleneck" in the current treatment method which when pulmonary metastasis occurs, or surgical treatment is not Enneking appropriate. Under such circumstances, the choice of treatment can be an issue. Case A 16-year-old male patient with multiple metastases of skull osteosarcoma was reported. The patient suffered not only tinnitus and hearing loss in the right ear but also right facial paralysis and headache. The preoperative brain MRI showed a tumor in the right cerebellopontine angle (CPA) area. He underwent skull tumor resection at another hospital in November 2018, during which process the biopsy revealed epithelioid osteoblastoma-like osteosarcoma. The patient had supplemental radiotherapy 1 month after surgery because of tumor recurrence. 32 months afterward, pulmonary metastases and multiple bone metastases were found. Then the patient underwent multiple conservative treatments which include Denosumab, Anlotinib, and DIA (cisplatin + ifosfamide + doxorubicin) chemotherapy at our hospital. After a series of 6 cycles of treatment, the patient can walk without aid. Lactate dehydrogenase (LDH) and Alkaline phosphatase (AKP) returned to a normal level. Fluorodeoxyglucose (FDG) metabolism in all bone metastases decreased to normal except for the ones in the proximal left femur, and the FDG metabolism in the left femur is significantly lower than that before treatment. Multiple bone metastases showed different extents of high-density calcification, and the volume of the local bone metastases has been reduced significantly. The patient's condition stayed stable at latest follow-up. Conclusion We found that multiple conservative treatments, which include Denosumab, Anlotinib and DIA chemotherapy, can improve patients' life quality, and help avoid further osteolytic destruction for patients with skull osteosarcoma and multiple metastases. Its specific mechanism and scope of the application still need to be further studied.
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Wang P, Li B, Zhou S, Xin Y, Zhu Z, Duan S, Bai D, Yuan H, Xu W, Xiao J. Efficacy and safety of COVID-19 vaccines for patients with spinal tumors receiving denosumab treatment: An initial real-clinical experience study. Front Oncol 2023; 13:1034466. [PMID: 37035168 PMCID: PMC10073434 DOI: 10.3389/fonc.2023.1034466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/28/2023] [Indexed: 04/11/2023] Open
Abstract
Background Even if COVID-19 vaccine has gradually been adopted in the world, information of side effects and crosstalk in patients with spinal tumors is absent due to the exclusion from clinical research. In this research, we aimed to investigate the efficacy and safety for the patients with spinal tumors treated by denosumab. Methods In this retrospective research, 400 patients under treatment of denosumab against spinal tumors in real-clinical experience were grouped into two cohorts according to the treatment of COVID-19 vaccine. And linked hospital data, serum samples and unsolicited related adverse events had been collected from January 22nd 2021 to June 1st 2021 respectively. Results 233 patients of all participants who received regular treatment of denosumab were vaccinated by mRNA or inactivated vaccine. Patients of metastatic disease and primary osseous spinal tumor showed similar distribution in both two groups. Over the study period, within 176 patients tested the status of serologic response of vaccine, 88(81.48%) and 41(87.23%) individuals injected one or two inactivated vaccines had effective antibody against SARS-CoV-2 infections. As 21 patients (85.71%) treated by mRNA vaccine did. Considering of the safety of vaccine, most common systemic adverse events were nausea or vomiting (45 events vs 23events). Interestingly, fewer participants in the vaccine group were statistically recorded in local adverse events than in the placebo group (16 events vs 33 events). Conclusions Our initial real-clinical experience suggests that COVID-19 vaccines are likely safe and effective in in patients with spinal tumors receiving denosumab treatment.
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Affiliation(s)
- Pengru Wang
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Bo Li
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Shangbin Zhou
- Naval Medical Center, Naval Military Medical University, Shanghai, China
| | - Yingye Xin
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhipeng Zhu
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Shujie Duan
- Department of Orthopedic, Changning County People's Hospital, Yunnan, China
| | - Danyang Bai
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Hao Yuan
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wei Xu
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
- *Correspondence: Jianru Xiao, ; Wei Xu,
| | - Jianru Xiao
- Department of Orthopedic Oncology, Changzheng Hospital, Second Military Medical University, Shanghai, China
- *Correspondence: Jianru Xiao, ; Wei Xu,
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Lange N, Jörger AK, Ryang YM, Liesche-Starnecker F, Gempt J, Meyer B. Primary Bone Tumors of the Spine—Proposal for Treatment Based on a Single Centre Experience. Diagnostics (Basel) 2022; 12:diagnostics12092264. [PMID: 36140664 PMCID: PMC9498005 DOI: 10.3390/diagnostics12092264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/13/2022] [Accepted: 09/15/2022] [Indexed: 12/03/2022] Open
Abstract
This study reports a large single-center series of primary bone tumors of the spine (PBTs). We aimed to review the concepts for management, as this kind of tumor represents a very rare entity, and also propose a new treatment algorithm. Retrospective analysis revealed 92 patients receiving surgery for PBTs from 2007 to 2019 at our center. They were analyzed based on surgical management and the course of the disease. A total of 145 surgical procedures were performed (50 cervical, 46 thoracic, 28 lumbar, and 21 sacral). Complete tumor resection was achieved in 65%, of which 22% showed tumor recurrence during follow-up (mean time to recurrence 334 days). The five-year mortality rate was significantly lower after complete resection (3% versus 25% after subtotal resection). Most of the patients improved in their symptoms through surgery. Regarding the tumor entity, the most common PBTs were vertebral hemangiomas (20%), osteoid osteomas (15%), and chordomas (16%). The Enneking graduation system showed a good correlation with the risk of recurrence and mortality. Complete resection in PBTs increased survival rates and remains the method of choice. Thus, quality of life—especially with a higher extent of resection—should be considered.
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Affiliation(s)
- Nicole Lange
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany
- Correspondence:
| | - Ann-Kathrin Jörger
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany
| | - Yu-Mi Ryang
- Department of Neurosurgery, Helios Klinikum Berlin-Buch, 13125 Berlin, Germany
| | | | - Jens Gempt
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum Rechts der Isar, Technical University, 81675 Munich, Germany
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Muramatsu K, Tani Y, Seto T, Roces G, Yamamoto M, Ichihara Y, Sakai T. Two cases with giant cell tumor arising from the sternum: Diagnosis and options for treatment. J Orthop Sci 2022; 27:1143-1148. [PMID: 32001081 DOI: 10.1016/j.jos.2019.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 10/12/2019] [Accepted: 10/23/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Keiichi Muramatsu
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, 759-4101, Japan; Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, 755-8505, Japan.
| | - Yasuhiro Tani
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, 759-4101, Japan
| | - Tetsuya Seto
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, 759-4101, Japan
| | - Gaston Roces
- Department of Orthopedic Surgery, Nagato General Hospital, Nagato, Yamaguchi, 759-4101, Japan
| | - Manabu Yamamoto
- Department of Orthopedic Surgery, Tokuyama Central Hospital, Shunan, Yamaguchi, 749-8522, Japan
| | - Yusuke Ichihara
- Department of Orthopedic Surgery, Tokuyama Central Hospital, Shunan, Yamaguchi, 749-8522, Japan
| | - Takashi Sakai
- Department of Orthopedic Surgery, Yamaguchi University School of Medicine, Ube, Yamaguchi, 755-8505, Japan
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Chen Q, Wu J, Zheng K, Xu M, Hou Z, Yu X. Successful limb salvage in progressive proximal tibia osteosarcoma following denosumab chemotherapy: A case report. Medicine (Baltimore) 2022; 101:e29812. [PMID: 35905210 PMCID: PMC9333532 DOI: 10.1097/md.0000000000029812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Osteosarcoma (OS) is a primary malignant bone tumor that originates in the mesenchymal tissue. It is the most common type of pleomorphic tumor occurring in children and adolescents. Currently, there is no established systematic treatment for OS that progresses during standard preoperative chemotherapy. PATIENT CONCERNS AND DIAGNOSES We describe a 14-year-old male patient with a 4-month history of pain in the upper right leg. Based on the results of percutaneous biopsy, a diagnosis of OS was made. After admission, the patient was treated with first-line chemotherapy agents. After a single course of treatment, the tumor progressed locally and no limb salvage was feasible. INTERVENTIONS AND OUTCOMES Intervention with denosumab combined with chemotherapy led to a significant reduction in tumor volume and ossification of soft tissue, which successfully resulted in limb salvage rather than amputation. The patient showed no evidence of recurrent or distant metastasis at 6-month follow-up. LESSONS Treatment with receptor activator of nuclear factor-ĸB ligand inhibitor denosumab combined with standard chemotherapy is effective for advanced OS progressing after chemotherapy. We recommend denosumab therapy for successful limb salvage in patients with high-grade OS associated with osteolytic bone destruction and refractory to preoperative neoadjuvant chemotherapy.
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Affiliation(s)
- Qian Chen
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Junjie Wu
- Weifang Medical University, Weifang, Shandong, China
| | - Kai Zheng
- Department of Orthopedics, The 960th Hospital of the People’s Liberation Army, Jinan, Shandong, China
| | - Ming Xu
- Department of Orthopedics, The 960th Hospital of the People’s Liberation Army, Jinan, Shandong, China
| | - Ziwei Hou
- First Clinical Medical College, Shandong University of Traditional Chinese Medicine, Jinan, Shandong, China
| | - Xiuchun Yu
- Department of Orthopedics, The 960th Hospital of the People’s Liberation Army, Jinan, Shandong, China
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Origin and Therapies of Osteosarcoma. Cancers (Basel) 2022; 14:cancers14143503. [PMID: 35884563 PMCID: PMC9322921 DOI: 10.3390/cancers14143503] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 01/15/2023] Open
Abstract
Simple Summary Osteosarcoma is the most common malignant bone tumor in children, with a 5-year survival rate ranging from 70% to 20% depending on the aggressiveness of the disease. The current treatments have not evolved over the past four decades due in part to the genetic complexity of the disease and its heterogeneity. This review will summarize the current knowledge of OS origin, diagnosis and therapies. Abstract Osteosarcoma (OS) is the most frequent primary bone tumor, mainly affecting children and young adults. Despite therapeutic advances, the 5-year survival rate is 70% but drastically decreases to 20–30% for poor responders to therapies or for patients with metastasis. No real evolution of the survival rates has been observed for four decades, explained by poor knowledge of the origin, difficulties related to diagnosis and the lack of targeted therapies for this pediatric tumor. This review will describe a non-exhaustive overview of osteosarcoma disease from a clinical and biological point of view, describing the origin, diagnosis and therapies.
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Li J, Wang X, Li Y, Cao Q, Bu Y, Cao H, Wang X. Pathological Clinical Analysis and Imaging Manifestations for Spinal Bone Tumors Based on Cement Injection. Appl Bionics Biomech 2022; 2022:2105332. [PMID: 35510043 PMCID: PMC9061064 DOI: 10.1155/2022/2105332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 04/08/2022] [Accepted: 04/12/2022] [Indexed: 11/17/2022] Open
Abstract
In order to explore the imaging manifestations and pathological characteristics of spine tumors, this article explores the clinical diagnosis and treatment methods through multi-sample case analysis with the support of imaging, and proposes a targeted treatment method that uses a special PVP needle with a beveled puncture surface for puncture. Moreover, this article uses the supporting PVP syringe for bone cement injection, develops a health status questionnaire, and adopts a scoring method for comprehensive assessment. The purpose of this article is to show that through the combination of preoperative radiotherapy and postoperative bracing, bone cement injection to treat vertebral tumors can immediately obtain satisfactory pain relief. Finally, through case analysis and image performance, we can see that the method proposed in this article has a certain effect.
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Affiliation(s)
- Jie Li
- Department of Spine, Second Hospital of Tangshan, Tangshan, Hebei, China 063000
| | - Xu Wang
- Department of Spine, Second Hospital of Tangshan, Tangshan, Hebei, China 063000
| | - Yongmin Li
- Department of Spine, Second Hospital of Tangshan, Tangshan, Hebei, China 063000
| | - Qinhui Cao
- Department of Spine, Second Hospital of Tangshan, Tangshan, Hebei, China 063000
| | - Yi Bu
- Department of Spine, Second Hospital of Tangshan, Tangshan, Hebei, China 063000
| | - Hengcong Cao
- Department of Spine, Second Hospital of Tangshan, Tangshan, Hebei, China 063000
| | - Xiaoqiang Wang
- Department of Neurosurgery, Xinhua Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai, China 200000
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De Salvo S, Pavone V, Coco S, Dell’Agli E, Blatti C, Testa G. Benign Bone Tumors: An Overview of What We Know Today. J Clin Med 2022; 11:jcm11030699. [PMID: 35160146 PMCID: PMC8836463 DOI: 10.3390/jcm11030699] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/14/2022] [Accepted: 01/27/2022] [Indexed: 12/14/2022] Open
Abstract
Nonmalignant bone tumors represent a wide variety of different entities but maintain many common features. They usually affect young patients, and most can be diagnosed through imaging exams. Often asymptomatic, they can be discovered incidentally. Due to their similarities, these tumors may be challenging to diagnose and differentiate between each other, thus the need for a complete and clear description of their main characteristics. The aim of this review is to give a picture of the benign bone tumors that clinicians can encounter more frequently in their everyday work.
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12
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Biologic Reconstruction With a Motorized Intramedullary Bone Transport Nail After Tumor Resection. J Orthop Trauma 2021; 35:S25-S30. [PMID: 34533483 DOI: 10.1097/bot.0000000000002118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/09/2021] [Indexed: 02/02/2023]
Abstract
Distraction osteogenesis is an option for reconstruction of intercalary defects. The use of bone transport after tumor surgery has been limited because of concerns of pin tract infections with external fixation and the theoretical risk of causing tumor growth. The effects of chemotherapy and radiation on the regenerate and healing of the docking site are also not well studied, but the current literature has mostly favorable outcomes with no evidence of causing tumor proliferation. The Precice bone transport nail offers a noninvasive method of distraction osteogenesis, which eliminates the need for prolonged external fixation and the risk of pin tract infections. This report discusses the technique for using the Precice bone transport nail after tumor resection. Bone transport may be considered for intercalary defects after en bloc resection of sarcoma, metastatic disease, and benign aggressive bone tumors. The use of distraction osteogenesis after tumor resection is a promising technique for the biologic reconstruction of intercalary defects.
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Bădilă AE, Rădulescu DM, Niculescu AG, Grumezescu AM, Rădulescu M, Rădulescu AR. Recent Advances in the Treatment of Bone Metastases and Primary Bone Tumors: An Up-to-Date Review. Cancers (Basel) 2021; 13:4229. [PMID: 34439383 PMCID: PMC8392383 DOI: 10.3390/cancers13164229] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 08/14/2021] [Accepted: 08/20/2021] [Indexed: 12/13/2022] Open
Abstract
In the last decades, the treatment of primary and secondary bone tumors has faced a slow-down in its development, being mainly based on chemotherapy, radiotherapy, and surgical interventions. However, these conventional therapeutic strategies present a series of disadvantages (e.g., multidrug resistance, tumor recurrence, severe side effects, formation of large bone defects), which limit their application and efficacy. In recent years, these procedures were combined with several adjuvant therapies, with different degrees of success. To overcome the drawbacks of current therapies and improve treatment outcomes, other strategies started being investigated, like carrier-mediated drug delivery, bone substitutes for repairing bone defects, and multifunctional scaffolds with bone tissue regeneration and antitumor properties. Thus, this paper aims to present the types of bone tumors and their current treatment approaches, further focusing on the recent advances in new therapeutic alternatives.
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Affiliation(s)
- Adrian Emilian Bădilă
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.E.B.); (D.M.R.); (A.R.R.)
- Department of Orthopedics and Traumatology, Bucharest University Hospital, 050098 Bucharest, Romania
| | - Dragoș Mihai Rădulescu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.E.B.); (D.M.R.); (A.R.R.)
- Department of Orthopedics and Traumatology, Bucharest University Hospital, 050098 Bucharest, Romania
| | - Adelina-Gabriela Niculescu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania; (A.-G.N.); (A.M.G.)
| | - Alexandru Mihai Grumezescu
- Faculty of Applied Chemistry and Materials Science, University Politehnica of Bucharest, 060042 Bucharest, Romania; (A.-G.N.); (A.M.G.)
- Research Institute of the University of Bucharest—ICUB, University of Bucharest, 050657 Bucharest, Romania
- Academy of Romanian Scientists, 3 Ilfov Street, 50044 Bucharest, Romania
| | - Marius Rădulescu
- Department of Inorganic Chemistry, Physical Chemistry and Electrochemistry, University Politehnica of Bucharest, 1-7 Polizu St., 011061 Bucharest, Romania
| | - Adrian Radu Rădulescu
- “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania; (A.E.B.); (D.M.R.); (A.R.R.)
- Department of Orthopedics and Traumatology, Bucharest University Hospital, 050098 Bucharest, Romania
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Abstract
PURPOSE OF REVIEW Osteosarcoma (OSA) is the most common primary tumor of bone, mainly affecting children and adolescents. Here we discuss recent advances in surgical and systemic therapies, and highlight potentially new modalities in preclinical evaluation and prognostication. RECENT FINDINGS The advent of neoadjuvant and adjuvant chemotherapy has markedly improved the disease-free recurrence and overall survival of OSA. However, treatment efficacy has been stagnant since the 1980s. This plateau has prompted preclinical and clinical research into in precision surgery, inhaled chemotherapy to increase pulmonary drug concentration without systemic side effects, and novel immunomodulators intended to block molecular pathways associated with OSA proliferation and metastasis. With the advent of novel surgical techniques and new forms and vectors for chemotherapy, it is hoped that OSA treatment outcomes will exceed their currently sustained plateau in the near future.
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Affiliation(s)
- Rebekah Belayneh
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Mitchell S Fourman
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sumail Bhogal
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kurt R Weiss
- Division of Orthopaedic Oncology, Department of Orthopaedic Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
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Chandhanayingyong C, Srikong K, Puncreobutr C, Lohwongwatana B, Phimolsarnti R, Chuckpaiwong B. Three-dimensional printed, proximal phalangeal prosthesis with metatarsophalangeal joint arthroplasty for the treatment of a giant cell tumor of the fifth toe: The first case report. Int J Surg Case Rep 2020; 73:84-89. [PMID: 32650260 PMCID: PMC7341039 DOI: 10.1016/j.ijscr.2020.06.069] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 06/13/2020] [Accepted: 06/13/2020] [Indexed: 11/19/2022] Open
Abstract
Customized, single-piece, 3D-printed, titanium phalangeal prosthesis of the 5th toe. Replacement of whole proximal phalanx with a mobile joint distally and proximally. Patient walks with full weight-bearing, no pain, and no recurrence or metastasis. Overriding toe occurred after two years due to scar contracture. Prosthesis design development, including size reduction, may improve outcomes.
Introduction The majority of patients with bone sarcoma or an aggressive benign tumor of the toe can be successfully treated by amputation. However, limb-salvage surgery for toe tumors remains challenging. Presentation of case A 26-year-old female presented with an enlarging mass on her right 5th toe. Imaging studies revealed an expansile osteolytic, destructive lesion of the proximal phalanx of the 5th toe with metatarsophalangeal (MTP) joint invasion. A biopsy specimen confirmed a grade 1, giant cell tumor of the bone. An en bloc resection of the proximal phalanx was performed, and the defect was reconstructed with a patient-matched, three-dimensional, printed titanium proximal phalanx endoprosthesis with an MTP joint extension. The postoperative course was uneventful. The patient has walked with full weight-bearing since early postoperatively. No local recurrence or metastases were evident. However, scar formation occurred after two years, causing an overriding toe deformity. Discussion This case represents the first use of a toe prosthesis with MTP joint reconstruction. The complex MTP structure with a preserved metatarsal head facilitates the effort to mimic normal weight-bearing. Conclusion A three-dimensional printed prosthesis of the 5th toe is a viable alternative to a bone graft or amputation. However, to avoid stiffness and complications, further study is needed to improve the prosthesis design.
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Affiliation(s)
- Chandhanarat Chandhanayingyong
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
| | - Korakod Srikong
- Biomechanic Research Center, Meticuly Co Ltd., Chulalongkorn University, Bangkok, Thailand
| | - Chedtha Puncreobutr
- Advanced Materials Analysis Research Unit, Department of Metallurgical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand; Biomedical Engineering Research Center, Chulalongkorn University, Bangkok, Thailand
| | - Boonrat Lohwongwatana
- Advanced Materials Analysis Research Unit, Department of Metallurgical Engineering, Faculty of Engineering, Chulalongkorn University, Bangkok, Thailand; Biomedical Engineering Research Center, Chulalongkorn University, Bangkok, Thailand
| | - Rapin Phimolsarnti
- Division of Musculoskeletal Oncology, Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Bavornrit Chuckpaiwong
- Division of Foot and Ankle Surgery, Department of Orthopaedic Surgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Tsai TC, Chen CC, Huang HK, Wang JP. Modified Sauve-Kapandji Procedure Using Iliac Bone Graft for Giant Cell Tumor of the Distal Ulna: Stabilizing With Two-Screw Fixation: A Case Report. JBJS Case Connect 2020; 9:e0299. [PMID: 31211751 DOI: 10.2106/jbjs.cc.18.00299] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CASE We describe a 33-year-old man who had a giant cell tumor in the ulnar head treated with wide resection and reconstructed using the modified Sauve-Kapandji procedure with an iliac crest bone graft as ulnar support. CONCLUSIONS Due to the destructive nature of the tumor and the important role played by the ulnar head in the distal radioulnar joint (DRUJ), treatment of the giant cell tumor in the distal ulna is a challenge. The modified Sauve-Kapandji procedure is an effective technique to restore DRUJ function, which is performed as an ulnar support arthroplasty. Using an iliac crest bone graft as ulnar support in reconstruction surgery could be a practical method after the ulnar head has been resected.
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Affiliation(s)
- Ting-Chien Tsai
- Department of Orthopaedics, Chiayi Christian Hospital, Chiayi, Taiwan
| | - Chien-Chin Chen
- Department of Pathology, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi, Taiwan.,Department of Cosmetic Science, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Hui-Kuang Huang
- Department of Orthopaedics, Chiayi Christian Hospital, Chiayi, Taiwan.,Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan
| | - Jung-Pan Wang
- Department of Orthopaedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
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Corre I, Verrecchia F, Crenn V, Redini F, Trichet V. The Osteosarcoma Microenvironment: A Complex But Targetable Ecosystem. Cells 2020; 9:cells9040976. [PMID: 32326444 PMCID: PMC7226971 DOI: 10.3390/cells9040976] [Citation(s) in RCA: 233] [Impact Index Per Article: 58.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 04/06/2020] [Accepted: 04/11/2020] [Indexed: 01/08/2023] Open
Abstract
Osteosarcomas are the most frequent primary bone sarcomas, affecting mainly children, adolescents, and young adults, and with a second peak of incidence in elderly individuals. The current therapeutic management, a combined regimen of poly-chemotherapy and surgery, still remains largely insufficient, as patient survival has not improved in recent decades. Osteosarcomas are very heterogeneous tumors, both at the intra- and inter-tumor level, with no identified driver mutation. Consequently, efforts to improve treatments using targeted therapies have faced this lack of specific osteosarcoma targets. Nevertheless, these tumors are inextricably linked to their local microenvironment, composed of bone, stromal, vascular and immune cells and the osteosarcoma microenvironment is now considered to be essential and supportive for growth and dissemination. This review describes the different actors of the osteosarcoma microenvironment and gives an overview of the past, current, and future strategies of therapy targeting this complex ecosystem, with a focus on the role of extracellular vesicles and on the emergence of multi-kinase inhibitors.
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Affiliation(s)
- Isabelle Corre
- INSERM, Nantes University, UMR1238 Phy-Os “Bone Sarcomas and Remodeling of Calcified Tissues”, F-44035 Nantes, France
- CNRS GDR3697 MicroNit, F-37044 Tours, France
- Correspondence: (I.C.); (V.T.)
| | - Franck Verrecchia
- INSERM, Nantes University, UMR1238 Phy-Os “Bone Sarcomas and Remodeling of Calcified Tissues”, F-44035 Nantes, France
| | - Vincent Crenn
- INSERM, Nantes University, UMR1238 Phy-Os “Bone Sarcomas and Remodeling of Calcified Tissues”, F-44035 Nantes, France
- Department of Orthopedic, Nantes Hospital, CHU Hotel-Dieu, F-44035 Nantes, France
| | - Francoise Redini
- INSERM, Nantes University, UMR1238 Phy-Os “Bone Sarcomas and Remodeling of Calcified Tissues”, F-44035 Nantes, France
| | - Valérie Trichet
- INSERM, Nantes University, UMR1238 Phy-Os “Bone Sarcomas and Remodeling of Calcified Tissues”, F-44035 Nantes, France
- CNRS GDR3697 MicroNit, F-37044 Tours, France
- Correspondence: (I.C.); (V.T.)
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Dürr HR, Grahneis F, Baur-Melnyk A, Knösel T, Birkenmaier C, Jansson V, Klein A. Aneurysmal bone cyst: results of an off label treatment with Denosumab. BMC Musculoskelet Disord 2019; 20:456. [PMID: 31630689 PMCID: PMC6802343 DOI: 10.1186/s12891-019-2855-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 09/27/2019] [Indexed: 12/11/2022] Open
Abstract
Background The treatment of aneurysmal bone cysts (ABCs) has evolved and less invasive methods have been tried. Denosumab is a monoclonal antibody which inhibits osteoclasts. It has been shown to be effective in giant cell tumour of bone (GCT) of bone and hence promises some effect also in ABC. We report on 6 patients treated with Denosumab and compare our results to the cases already published. Methods Data of 6 patients with ABCs and patients whose treatment included Denosumab were retrospectively analyzed. Denosumab was used at a dose of 120 mg on days 1, 8, 15 and 29, and every 4 weeks thereafter. In some of these patients the dose was reduced at the end of the treatment. Clinical and radiological responses were evaluated. Results In 4 female and 2 male patients with a mean age of 17 years (range: 6–30 years) the lesions were located in the sacrum (2), in distal radius, distal femur, talus and pelvis. One of the sacral lesions healed after 12 months and has stayed stable for 3 years since. The second patient received 2 years of therapy with recalcification, but recurred 1 year later and is under renewed therapy. The pelvic lesion improved but recurred. This patient has a 13-years history of intermittent therapy including surgery, two pregnancies and remains in a stable situation. The lesion of the talus did not improve with Denosumab after surgery and was complicated by destruction of the ankle joint with osteoarthritis. Recurrent lesions of the distal femur and the distal radius, previously treated by curettage and bone grafting healed under Denosumab and have remained stable for 2 and 3 years, respectively. One case of severe hypercalcemia was observed in a 7-year old child 6 months after discontinuation of Denosumab. Conclusion Denosumab provides a treatment option for ABCs in anatomically critical locations. Adjuvant application might reduce the rate of local recurrence. In young patients, severe rebound hypercalcemia months after discontinuation of Denosumab may occur.
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Affiliation(s)
- Hans Roland Dürr
- Orthopaedic Oncology, Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistr. 15, D-81377, Munich, Germany.
| | - Ferdinand Grahneis
- Orthopaedic Oncology, Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistr. 15, D-81377, Munich, Germany
| | - Andrea Baur-Melnyk
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Thomas Knösel
- Institute of Pathology, University Hospital, LMU Munich, Munich, Germany
| | - Christof Birkenmaier
- Orthopaedic Oncology, Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistr. 15, D-81377, Munich, Germany
| | - Volkmar Jansson
- Orthopaedic Oncology, Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistr. 15, D-81377, Munich, Germany
| | - Alexander Klein
- Orthopaedic Oncology, Department of Orthopaedics, Physical Medicine and Rehabilitation, University Hospital, LMU Munich, Marchioninistr. 15, D-81377, Munich, Germany
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Sobacchi C, Menale C, Villa A. The RANKL-RANK Axis: A Bone to Thymus Round Trip. Front Immunol 2019; 10:629. [PMID: 30984193 PMCID: PMC6450200 DOI: 10.3389/fimmu.2019.00629] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 03/08/2019] [Indexed: 12/13/2022] Open
Abstract
The identification of Receptor activator of nuclear factor kappa B ligand (RANKL) and its cognate receptor Receptor activator of nuclear factor kappa B (RANK) during a search for novel tumor necrosis factor receptor (TNFR) superfamily members has dramatically changed the scenario of bone biology by providing the functional and biochemical proof that RANKL signaling via RANK is the master factor for osteoclastogenesis. In parallel, two independent studies reported the identification of mouse RANKL on activated T cells and of a ligand for osteoprotegerin on a murine bone marrow-derived stromal cell line. After these seminal findings, accumulating data indicated RANKL and RANK not only as essential players for the development and activation of osteoclasts, but also for the correct differentiation of medullary thymic epithelial cells (mTECs) that act as mediators of the central tolerance process by which self-reactive T cells are eliminated while regulatory T cells are generated. In light of the RANKL-RANK multi-task function, an antibody targeting this pathway, denosumab, is now commonly used in the therapy of bone loss diseases including chronic inflammatory bone disorders and osteolytic bone metastases; furthermore, preclinical data support the therapeutic application of denosumab in the framework of a broader spectrum of tumors. Here, we discuss advances in cellular and molecular mechanisms elicited by RANKL-RANK pathway in the bone and thymus, and the extent to which its inhibition or augmentation can be translated in the clinical arena.
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Affiliation(s)
- Cristina Sobacchi
- Milan Unit, Institute for Genetic and Biomedical Research (CNR-IRGB), Milan, Italy.,Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Ciro Menale
- Milan Unit, Institute for Genetic and Biomedical Research (CNR-IRGB), Milan, Italy.,Humanitas Clinical and Research Center IRCCS, Rozzano, Italy
| | - Anna Villa
- Milan Unit, Institute for Genetic and Biomedical Research (CNR-IRGB), Milan, Italy.,San Raffaele Telethon Institute for Gene Therapy (SR-Tiget), IRCCS San Raffaele Scientific Institute, Milan, Italy
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20
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Medler J, Nelke J, Weisenberger D, Steinfatt T, Rothaug M, Berr S, Hünig T, Beilhack A, Wajant H. TNFRSF receptor-specific antibody fusion proteins with targeting controlled FcγR-independent agonistic activity. Cell Death Dis 2019; 10:224. [PMID: 30833543 PMCID: PMC6399339 DOI: 10.1038/s41419-019-1456-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2018] [Revised: 02/10/2019] [Accepted: 02/12/2019] [Indexed: 01/08/2023]
Abstract
Antibodies specific for TNFRSF receptors that bind soluble ligands without getting properly activated generally act as strong agonists upon FcγR binding. Systematic analyses revealed that the FcγR dependency of such antibodies to act as potent agonists is largely independent from isotype, FcγR type, and of the epitope recognized. This suggests that the sole cellular attachment, achieved by Fc domain-FcγR interaction, dominantly determines the agonistic activity of antibodies recognizing TNFRSF receptors poorly responsive to soluble ligands. In accordance with this hypothesis, we demonstrated that antibody fusion proteins harboring domains allowing FcγR-independent cell surface anchoring also act as strong agonist provided they have access to their target. This finding defines a general possibility to generate anti-TNFRSF receptor antibodies with FcγR-independent agonism. Moreover, anti-TNFRSF receptor antibody fusion proteins with an anchoring domain promise superior applicability to conventional systemically active agonists when an anchoring target with localized disease associated expression can be addressed.
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Affiliation(s)
- Juliane Medler
- Division of Molecular Internal Medicine, Department of Internal Medicine II, University Hospital Würzburg, Auvera Haus Grombühlstraße 12, 97080, Würzburg, Germany
| | - Johannes Nelke
- Division of Molecular Internal Medicine, Department of Internal Medicine II, University Hospital Würzburg, Auvera Haus Grombühlstraße 12, 97080, Würzburg, Germany
| | - Daniela Weisenberger
- Division of Molecular Internal Medicine, Department of Internal Medicine II, University Hospital Würzburg, Auvera Haus Grombühlstraße 12, 97080, Würzburg, Germany
| | - Tim Steinfatt
- Department of Internal Medicine II, University Hospital of Würzburg, Zinklesweg 10, 97078, Würzburg, Germany
| | - Moritz Rothaug
- Division of Molecular Internal Medicine, Department of Internal Medicine II, University Hospital Würzburg, Auvera Haus Grombühlstraße 12, 97080, Würzburg, Germany
| | - Susanne Berr
- Institute of Virology and Immunobiology, University of Würzburg, Versbacher Str. 7, 97078, Würzburg, Germany
| | - Thomas Hünig
- Institute of Virology and Immunobiology, University of Würzburg, Versbacher Str. 7, 97078, Würzburg, Germany
| | - Andreas Beilhack
- Department of Internal Medicine II, University Hospital of Würzburg, Zinklesweg 10, 97078, Würzburg, Germany
| | - Harald Wajant
- Division of Molecular Internal Medicine, Department of Internal Medicine II, University Hospital Würzburg, Auvera Haus Grombühlstraße 12, 97080, Würzburg, Germany.
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The RANK-RANKL axis: an opportunity for drug repurposing in cancer? Clin Transl Oncol 2019; 21:977-991. [PMID: 30656607 DOI: 10.1007/s12094-018-02023-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Accepted: 12/18/2018] [Indexed: 12/12/2022]
Abstract
Drug repurposing offers advantages over traditional drug development in terms of cost, speed and improved patient outcomes. The receptor activator of nuclear factor kappa B (RANK) ligand (RANKL) inhibitor denosumab is approved for the prevention of skeletal-related events in patients with advanced malignancies involving bone, including solid tumours and multiple myeloma. Following improved understanding of the role of RANK/RANKL in cancer biology, denosumab has already been repurposed as a treatment for giant cell tumour of bone. Here, we review the role of RANK/RANKL in tumourigenesis, including effects on tumour initiation, progression and metastasis and consider the impact of RANK/RANKL on tumour immunology and immune evasion. Finally, we look briefly at ongoing trials and future opportunities for therapeutic synergy when combining denosumab with anti-cancer agents such as immune checkpoint inhibitors.
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Corraliza-Gorjón I, Somovilla-Crespo B, Santamaria S, Garcia-Sanz JA, Kremer L. New Strategies Using Antibody Combinations to Increase Cancer Treatment Effectiveness. Front Immunol 2017; 8:1804. [PMID: 29312320 PMCID: PMC5742572 DOI: 10.3389/fimmu.2017.01804] [Citation(s) in RCA: 45] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/30/2017] [Indexed: 12/14/2022] Open
Abstract
Antibodies have proven their high value in antitumor therapy over the last two decades. They are currently being used as the first-choice to treat some of the most frequent metastatic cancers, like HER2+ breast cancers or colorectal cancers, currently treated with trastuzumab (Herceptin) and bevacizumab (Avastin), respectively. The impressive therapeutic success of antibodies inhibiting immune checkpoints has extended the use of therapeutic antibodies to previously unanticipated tumor types. These anti-immune checkpoint antibodies allowed the cure of patients devoid of other therapeutic options, through the recovery of the patient’s own immune response against the tumor. In this review, we describe how the antibody-based therapies will evolve, including the use of antibodies in combinations, their main characteristics, advantages, and how they could contribute to significantly increase the chances of success in cancer therapy. Indeed, novel combinations will consist of mixtures of antibodies against either different epitopes of the same molecule or different targets on the same tumor cell; bispecific or multispecific antibodies able of simultaneously binding tumor cells, immune cells or extracellular molecules; immunomodulatory antibodies; antibody-based molecules, including fusion proteins between a ligand or a receptor domain and the IgG Fab or Fc fragments; autologous or heterologous cells; and different formats of vaccines. Through complementary mechanisms of action, these combinations could contribute to elude the current limitations of a single antibody which recognizes only one particular epitope. These combinations may allow the simultaneous attack of the cancer cells by using the help of the own immune cells and exerting wider therapeutic effects, based on a more specific, fast, and robust response, trying to mimic the action of the immune system.
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Affiliation(s)
- Isabel Corraliza-Gorjón
- Department of Immunology and Oncology, Centro Nacional de Biotecnologia (CNB-CSIC), Madrid, Spain
| | - Beatriz Somovilla-Crespo
- Department of Immunology and Oncology, Centro Nacional de Biotecnologia (CNB-CSIC), Madrid, Spain
| | - Silvia Santamaria
- Department of Cellular and Molecular Medicine, Centro de Investigaciones Biologicas (CIB-CSIC), Madrid, Spain
| | - Jose A Garcia-Sanz
- Department of Cellular and Molecular Medicine, Centro de Investigaciones Biologicas (CIB-CSIC), Madrid, Spain
| | - Leonor Kremer
- Department of Immunology and Oncology, Centro Nacional de Biotecnologia (CNB-CSIC), Madrid, Spain
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