Summary

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• This summary is based on the review of 22 systematic review(s)/meta-analysis(es). ^[1-20]
• Hypercalcemia of Malignancy (HCM): Denosumab achieved non-inferiority to intravenous bisphosphonates in resolving hypercalcemia, with two-thirds of patients with refractory/recurrent HCM responding to denosumab after prior bisphosphonate therapy.
• Multiple Myeloma (MM): Denosumab was non-inferior to zoledronic acid in overall survival, progression-free survival, and reducing skeletal-related events (SREs).
• Giant Cell Tumor of Bone (GCTB): While denosumab was effective in long-term disease control, higher recurrence rates were observed post-curettage despite its use.
• Bone Metastasis from Lung Cancer: Denosumab ranked higher than zoledronic acid for overall survival and time to first SRE (3) (hazard ratio (HR) = 0.86; 95% confidence interval (CI), 0.80-0.93; P = 0.0001), also reducing pathological fractures more effectively.
• No significant difference in the adverse event rate was observed between denosumab and bisphosphonates in HCM patients.
• Similar rates of osteonecrosis of the jaw (ONJ (relative risk (RR) 3.45, 95% CI 1.06 to 11.24; per 1000 participants 30 more (1 more to 125 more)) were reported for multiple myeloma patients treated with denosumab and zoledronic acid, while denosumab showed a better safety profile for renal toxicity.
• Denosumab-treated patients with bone metastasis from lung cancer exhibited a higher incidence of hypocalcemia and ONJ compared to those treated with zoledronic acid, but had fewer cases of renal toxicity and acute phase reactions.
• Denosumab is effective in specific populations, such as adults with refractory/recurrent HCM who did not respond to bisphosphonates, patients with MM, and patients with bone metastasis from lung or prostate cancer, showing similar or superior outcomes compared to bisphosphonates in terms of survival, progression, and skeletal-related events, though higher recurrence rates were observed in GCTB following curettage with denosumab.