Subcutaneous Denosumab for Treatment of Central Giant Cell Granuloma of the Jaws

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Various medical modalities have been reported in an attempt to decrease the need for or extent of surgical intervention required for the treatment of central giant cell granulomas (CGCG) of the jaws, with subcutaneous denosumab injections being described most recently.1 The authors report their experience with the presentation of 7 cases that were treated with subcutaneous denosumab.A retrospective chart review was performed at Mount Sinai Hospital in Toronto, ON, identifying patients treated with denosumab for CGCG of the jaws. Patients were treated with 120mg of subcutaneously administered denosumab on a monthly basis, with additional loading doses on days 8 and 15.2 Clinical and radiographic response, as well as the need for surgical intervention, were assessed for the treatment and follow-up period (range: 8-30 months). Descriptive statistics were reported.Of the 7 patients identified, 2 patients had a clinically aggressive subtype and 5 were non-aggressive. Six patients received denosumab as the primary treatment modality, whereas 1 was treated after an inadequate response to intralesional steroid injections. Patients were observed to have radiographic signs of calcification within 3 months of starting denosumab treatment without resolution of prior existing bony expansion. One patient opted for surgical recontouring, and the histologic analysis demonstrated fibro-osseous tissue without evidence of giant cells. One patient presented with lesion recurrence 7 months after completing only an 8-month course of denosumab treatment. The recurred lesion demonstrated re-calcification after the re-initiation of denosumab therapy.These results demonstrate that subcutaneous denosumab may be considered as a primary or adjunctive treatment for central giant cell granulomas of the jaws, though optimal treatment length and long-term outcomes need be further evaluated.