Denosumab as an Alternative Treatment in Cases of Giant Cell Tumors of the Mandible.

The giant cell tumor of the mandible is a local agressive benign tumor of the bone which is usually treated by wide excision. Nevertheless it has a high rate of recurrence, especially if in young patients the surgery is less radical in order to preserve teeth. A new non surgical treatment could be the medication with Denosumab. Denosumab is a human monoclonal IgG2 antibody that binds RANKL thereby inhibiting the stimulation of osteoclasts and giant cells. Two patients with recurrence of giant cell tumors of the mandible are treated since may and july 2014 with Denosumab 20 and 60mg every 3-6 months. The radiologic control after 20 and 22 months showed recalcification of the tumor and prevention of further growth. Treatment is well tolerated. The metabolism of Calcium is monitored closly without pathologic findings. The risc of a chemically induced osteonecrosis is low in young patients but should be considered. Denosumab should be evaluated as an alternative treatment to agressive surgery in cases of refractory giant cell tumor of the mandible. Keywords: Denosumab, jaw, mandible, giant cell tumor, osteonecrosis