Author/systemic treatment type

Side effects of medical treatment

Other adverse events/discontinuation

Study limitations

Balke et al. [19] /

Bisphosphonates

None

One patient with extensive pelvic disease died intraoperatively

Different treatment protocols

Chawla et al. [18] /RANK Ligand Antibody

84% (n = 236) of patient suffered at least one side effect. Grade 3, 4, or 5 adverse events occur in 18% (n = 50) of patients. Serious adverse (both related and unrelated to denosumab) events were noted in 9% (n = 25) of patients. Adverse events leading to treatment and study discontinuation occurred 5% (n = 14) and 5% (n = 13) of patients respectively.

One patient died from respiratory failure during the study unrelated to denosumab therapy. 21 patients discontinued the study in Cohort 1 and 20 patients discontinued the study in Cohort 2: Other adverse events: serious infections (2%, n = 5), and new primary malignancy (1%, n = 3).

Short follow-up time, no placebo group, and non-uniform follow-up amongst treating physicians