low recruitment with registration denosumab

This is a multicenter, randomised phase II trial in patients with high risk GCT.

Primary objective:

• Determine if adjuvant zoledronic acid improves the 2 years recurrence rate of 'high risk' GCT as compared to standard care

Secondary objectives:

• Determine the relapse free survival
• Evaluate the usefulness of bone remodelling markers in diagnosing and monitoring GCT

GCT is a potentially malignant tumour that presents with a locally destructive osteolytic lesion. The high risk GCT are characterized by a high recurrence rate around the 40-45%. Zoledronic acid is a potent inhibitor of osteolysis and is capable of inducing osteoclast and stromal cell apoptosis, which makes it an attractive adjuvant treatment in 'high risk' GCT in order to improve clinical outcomes and reduce the recurrence rate.

Inclusion Criteria:

• Signed written informed consent

• Male or female > 18 years of age

• Histologically proven GCT treated with surgery

• High risk GCT defined as minimal one or more of the following:

  • Recurrent GCT
  • GCT located in the pelvis, sacrum, spine, distal ulna or growth in soft tissue
  • GCT grade III
  • Pathological fracture in GCT
  • Absence of local adjuvant therapy (cryosurgery or phenol instillation)

• Neutrophils > 1.5x109/L, platelets > 100x109/L, and Hb > 6 mmol/l

• Bilirubin level < 1.5 x ULN

• ASAT and ALAT < 2.5 x ULN

• Adequate renal function as defined by: serum creatinine clearance > 60 cc/min

• Expected adequacy of follow-up

Exclusion Criteria:

• Unresectable or metastatic GCT and grade IV GCT
• Prior bisphosphonate usage, except preoperative treatment with zoledronic acid up to 3 months before surgery
• Other previous malignancy within 5 years, with exception of a history of a previous basal cell carcinoma of the skin or pre-invasive carcinoma of the cervix
• Known hypersensitivity reaction to any of the components of the treatment
• Pregnancy or lactating
• Medical or psychological condition which in the opinion of the investigator would not permit the patient to complete the study or sign meaningful informed consent