The effect of denosumab on disseminated tumor cells (DTCs) of breast cancer patients with neoadjuvant treatment: a GeparX translational substudy

Research output: Contribution to journalResearch articleContributedpeer-review


  • Pauline Wimberger - , Department of Gynecology and Obstetrics (Author)
  • Jens Uwe Blohmer - , Charité – Universitätsmedizin Berlin (Author)
  • Petra Krabisch - , Klinikum Chemnitz gGmbH (Author)
  • Theresa Link - , Department of Gynecology and Obstetrics (Author)
  • Marianne Just - , Onkologische Schwerpunktpraxis Bielefeld (Author)
  • Bruno Valentin Sinn - , Charité – Universitätsmedizin Berlin (Author)
  • Eike Simon - , Kreiskrankenhaus Torgau (Author)
  • Christine Solbach - , University Hospital Frankfurt (Author)
  • Tanja Fehm - , Heinrich Heine University Düsseldorf (Author)
  • Carsten Denkert - , University of Marburg (Author)
  • Cristin Kühn - , Katharinen-Hospital Unna (Author)
  • Kerstin Rhiem - , University of Cologne (Author)
  • Hans Tesch - , Agaplesion Markus Hospital Frankfurt (Author)
  • Sherko Kümmel - , University of Duisburg-Essen (Author)
  • Andrea Petzold - , Department of Gynecology and Obstetrics (Author)
  • Oliver Stötzer - , Gemeinschaftspraxis Hämatologie/Intern. Onkologie (Author)
  • Cornelia Meisel - , Department of Gynecology and Obstetrics (Author)
  • Jan Dominik Kuhlmann - , Department of Gynecology and Obstetrics (Author)
  • Valentina Nekljudova - , German Breast Group (Author)
  • Sibylle Loibl - , German Breast Group (Author)


Background: Disseminated tumor cells (DTCs) in the bone marrow are observed in about 40% at primary diagnosis of breast cancer and predict poor survival. While anti-resorptive therapy with bisphosphonates was shown to eradicate minimal residue disease in the bone marrow, the effect of denosumab on DTCs, particularly in the neoadjuvant setting, is largely unknown. The recent GeparX clinical trial reported that denosumab, applied as an add-on treatment to nab-paclitaxel based neoadjuvant chemotherapy (NACT), did not improve the patient’s pathologic complete response (pCR) rate. Herein, we analyzed the predictive value of DTCs for the response to NACT and interrogated whether neoadjuvant denosumab treatment may eradicate DTCs in the bone marrow. Methods: A total of 167 patients from the GeparX trial were analyzed for DTCs at baseline by immunocytochemistry using the pan-cytokeratin antibody A45-B/B3. Initially DTC-positive patients were re-analyzed for DTCs after NACT ± denosumab. Results: At baseline, DTCs were observed in 43/167 patients (25.7%) in the total cohort, however their presence did not predict response to nab-paclitaxel based NACT (pCR rates: 37.1% in DTC-negative vs. 32.6% DTC-positive; p = 0.713). Regarding breast cancer subtypes, the presence of DTCs at baseline was numerically associated with response to NACT in TNBC patients (pCR rates: 40.0% in DTC-positive vs. 66.7% in DTC-negative patients; p = 0.16). Overall, denosumab treatment did not significantly increase the given DTC-eradication rate of NACT (NACT: 69.6% DTC-eradication vs. NACT + denosumab: 77.8% DTC-eradication; p = 0.726). In TNBC patients with pCR, a numerical but statistically non-significant increase of DTC-eradication after NACT + denosumab was observed (NACT: 75% DTC-eradication vs. NACT + denosumab: 100% DTC-eradication; p = 1.00). Conclusion: This is the first study worldwide, demonstrating that neoadjuvant add-on denosumab over a short-term period of 24 months does not increase the DTC-eradication rate in breast cancer patients treated with NACT.


Original languageEnglish
Article number32
JournalBreast cancer research
Issue number1
Publication statusPublished - Dec 2023

External IDs

PubMed 36978142


Sustainable Development Goals

ASJC Scopus subject areas


  • Bone marrow, Denosumab, Disseminated tumor cells, GeparX trial, Neoadjuvant chemotherapy, Prognosis, Breast Neoplasms/pathology, Denosumab/therapeutic use, Triple Negative Breast Neoplasms, Humans, Neoplastic Cells, Circulating/pathology, Female, Neoadjuvant Therapy