ClinicalTrials.gg
CompletedNCT03270020Updated Jan 15, 2025

Denosumab for the Treatment of Adult LCH

A Phase 2 interventional study of Denosumab 70 MG/ML [Xgeva] in Langerhans Cell Histiocytosis, sponsored by Hellenic Society for the Study of Bone Metabolism. Completed at 1 site in Greece. Open to participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2025-01-15.

Sponsored by Hellenic Society for the Study of Bone Metabolism · Phase 2, Interventional, and Treatment

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Phase
Phase 2
Study type
Interventional
Enrollment
10
Allocation
Not applicable
Ages
18 Years and older
Sex
All
01

Study summary

This study is aiming to evaluate the efficacy of denosumab among adult patients suffering from Langerhans Cell Histiocytosis (LCH).

Read the detailed description

The majority and diversity of clinical manifestations in LCH are attributed to immunological dysfunction resulting from langerhans cell (LC) derived cytokine secretion both at the lesional and systemic level. In a recent study, Receptor Activator of Nuclear Factor Kappa-B Ligand (RANKL) was found to be abundantly expressed in cells within diverse LCH lesions from adult patients, especially in inflammatory infiltrates, a finding in line with a previously reported high osteoprotegerin (OPG) and low RANKL levels in the serum of patients with or without bone involvement. RANKL expression was associated with concomitant p65 Nuclear Factor Kappa-B (NFκB) nuclear staining, the main downstream effector of RANKL signaling, suggesting that lesional cell activation may be triggered locally by RANKL. Combining the serum and the lesional results, it can be inferred that there is an ongoing process of countervailing OPG production against lesional RANKL, which could be one of the self defense mechanisms among LCH patients. Therefore, the use of denosumab seems a rational treatment option in LCH in order to support and enhance the defensive OPG action and hopefully control or even interrupt the lesional immunological process.

The primary study objective is to assess the therapeutic efficacy of denosumab 120 mg every 8 weeks (Q8W) sc in adult LCH patients.

Secondary Objectives:

  1. To define an uniform treatment approach for LCH patients with mild symptoms and low risk disease.
  2. To explore the efficacy of denosumab 120 mg Q8W sc in reducing disease reactivations after treatment completion.
  3. To illustrate the safety profile of denosumab in LCH patients. The primary efficacy endpoint is defined as the percentage of patients with progression of disease at Month 8.
02

Conditions studied

  • Langerhans Cell Histiocytosis

Keywords

  • treatment
  • denosumab
  • Positron Emission Tomography (PET) CT scan
03

In context

Histiocytosis, Langerhans-Cell

81 studies on the registry are indexed under Histiocytosis, Langerhans-Cell; 23 are open to participants now.

This study's enrollment of 10 is below the median of 24 across 64 interventional studies indexed under Histiocytosis, Langerhans-Cell.

Browse Histiocytosis, Langerhans-Cell studies →

Lead sponsor

Hellenic Society for the Study of Bone Metabolism is the lead sponsor of 2 studies on the registry; none are open to participants now.

Counted across the registry records on this site, refreshed daily.

04

Who can participate

Ages eligible
18 Years and older
Sexes eligible
All
Accepts healthy volunteers
No

Go through the criteria one by one — yes, no or not sure — and take the list to your doctor or the study team. Kept in this browser only.

Inclusion criteria

  • Adults (>18 years of age)
  • Definitive diagnosis of LCH [Based on clinic-pathological evidence with microscopic examination and at least one of the following immunological staining: Langerin (CD 207) positivity, Cluster of Differentiation 1a (CD1a) positivity, Presence of Birbeck granules on electronic microscopy]
  • Mild symptoms (symptoms of low intensity; no need for hospitalization) and low risk disease needing systemic therapy for LCH because of:

    • single system disease with multifocal lesions, or
    • single system disease with "special site" lesions (vertebral lesions with intraspinal extension, craniofacial bone lesions with soft tissue extension), or
    • multi-system disease without involvement of risk organs [hematopoietic system, spleen, liver, tumorous central nervous system (CNS)].
  • Have signed the form (consent should be taken before any study-specific procedure is performed).
  • A patient should undergo a PET-CT imaging test, in order for him to be deemed suitable for the study. The initial PET-CT either may have been carried out, within 3 months prior to visit 1, regardless of the diagnostic center or the type of the device, which has been used for, or may take place in the context of visit 2, at the diagnostic center(s) specialized on Nuclear Medicine, which have been partnered with the Sponsor. Whichever is the case, the initial PET-CT report should be legible and accurate, so that to be assessed by the qualified physician, responsible for the PET-CT test at the partnered diagnostic center(s).

Exclusion criteria

Exclusion Criteria:

  • Symptomatic multi system LCH - no risk organs involved.
  • Multi-system LCH (with or without symptoms) - risk organs involved.
  • Isolated pulmonary LCH disease
  • Previous administration of denosumab from clinical trials or other use (e.g. commercial use).
  • Current participation in another clinical trial or having received any product within the last 3 months.
  • Impaired renal function as determined by an estimated (eGFR) of ≤ 30 mL/min/1,73m2 [using the Chronic Kidney Disease-Epidemiology, (CKD-EPI) formula].
  • Patients that have received oral bisphosphonates within 6 months of study enrollment or intravenous bisphosphonates, fluoride and strontium ranelate within 1 year of study enrollment.
  • Treatment with immune suppressive agents within 4 weeks from baseline evaluation.
  • Patients with severe impairment of clinical condition including: severely impaired pulmonary function [for example total lung capacity (TLC)\<60%, forced expiratory volume 1 ()\<30%, diffusing capacity of the lungs for carbon monoxide (DLCO)\<30%, partial pressure of oxygen (PaO2)\<55 mmHg), long term oxygen therapy or cor pulmonale.
  • Known to have a liver failure or chronic hepatic disease e.g. cirrhosis, chronic hepatitis; or elevated transaminases defined as (ALT) and/or aspartate aminotransferase (AST) > 2 fold the laboratory range.
  • Heart failure [ (NYHA) Functional Classification above 2].
  • Patients with of less than one year.
  • Female subjects of who refuse to use a reliable method throughout the study, defined as use of 2 highly effective forms of contraception and continuation of use for 7 months after last administration of study drug. Birth control methods that can achieve a failure rate of less than 1% per year, when used consistently and correctly, are considered as highly effective.
  • Pregnancy, planning a pregnancy or currently lactating
  • Severe concurrent illness which in the investigator's opinion may confound patient evaluation, e.g. (except basal cell carcinoma, cervical or breast ductal carcinoma in situ) within the last 5 years.
  • Known alcohol or drug abuse.
  • Parathyroid hormone (PTH), PTH derivatives, teriparatide, odanacatib, anabolic steroids, testosterone, glucocorticosteroids (> 5 mg/day of prednisone equivalent for > 10 days), systemic hormone-replacement therapy, selective estrogen receptor modulators (SERMs), raloxifene, tibolone, calcitonin use within the last 6 weeks.
  • Evidence of hyper- or hypothyroidism; patients with an abnormal thyroid stimulate hormone (TSH) level on thyroid treatment (patients on stable thyroid treatment with a normal TSH allowed); current hyper- or hypoparathyroidism; current hyper or hypocalcemia (hypercalcemia based on albumin adjusted serum calcium > 10.40 mg/dL; hypocalcemia based on albumin adjusted serum calcium \< 8.5 mg/dL); vitamin D deficiency (25-hydroxy vitamin D level \< 20 ng/mL; if the resulted value of the retest is 20 ≥ ng/Ml, after repletion with 50,000 - 100,000 IU of cholecalciferol, subject will be allowed. The retest should be carried out within 30 days post to visit 1(screening)); rheumatoid arthritis; Paget's disease; any known bone disease with osteolytic and/or osteoblastic lesions that would interfere with interpretation of findings.
  • Known sensitivity to mammalian cells, denosumab or any components of denosumab 120mg, or any of the products to be administered during the study (e.g., calcium or vitamin D).
  • History of any Solid Organ or Bone Marrow Transplant.
  • History of osteonecrosis of the jaw, and/or recent tooth extraction or other dental surgery; or planned invasive dental work during the study.
  • Intolerance to calcium supplements.
  • Malabsorption syndrome; severe malabsorption including Celiac disease, Short Bowel Syndrome, Crohn's disease, Previous Gastric Bypass.
Terms in these criteria, in plain language(12)

Underlined terms in the criteria open these too. Explained by clinicaltrials.gg, not part of the registry record. The study team decides who can take part.

Line of therapy

A line of therapy is one course of treatment, which may combine several drugs. First-line is the first course given; second-line follows when that stops working or is not tolerated.

“Two prior lines” means two courses that count separately under the study’s rules — not simply two drugs. Ask the study team if you are unsure how yours are counted.

Informed consent

Before you join, the study team explains what taking part involves — its purpose, what happens, the risks and possible benefits — and answers your questions, so you can decide freely. Consent is usually recorded on a form (the informed consent form, ICF) signed by you or, where the law allows, by someone legally authorised to decide for you.

You can keep asking questions during the study, you are told of new information that matters, and you can choose to leave at any time.

Investigational drug or device

A drug or device being studied in a clinical trial.

It may be new, or already approved and being studied for another use, dose or form. Criteria often leave out people who took part in another study of one within a recent period, commonly 30 days or five half-lives.

GFR and eGFR (kidney filtering)

GFR (glomerular filtration rate) is how much blood the kidneys filter each minute. It is usually estimated from a blood test — eGFR, by formulas such as CKD-EPI or MDRD — and some studies ask for it to be measured directly instead. Usually given in mL/min/1.73 m².

Check the method, the units and the minimum the study states. A value of 90 or above is in the normal-or-high range, but kidney damage can show in other tests too.

FEV1

From a breathing test (spirometry): how much air you can blow out in the first second. Often given as a percentage of what is expected for your age, height and sex.

ALT and AST (liver enzymes)

Two enzymes measured in a routine blood test of the liver. Higher levels can mean the liver is under strain or damaged. SGPT and SGOT are older names for ALT and AST.

Criteria usually give a limit as a multiple of the upper limit of normal (ULN), often higher when cancer has spread to the liver.

ULN (upper limit of normal)

The top of the normal range for a blood test, as set by the laboratory that runs it. Each lab prints its own range next to your result.

“≤ 2.5 × ULN” means the result can be up to two and a half times that top value.

NYHA class (heart failure)

The New York Heart Association’s four classes of how much heart failure limits physical activity.

I
No limits: ordinary activity causes no undue tiredness or breathlessness.
II
Slight limits: comfortable at rest, ordinary activity causes symptoms.
III
Marked limits: comfortable at rest, less than ordinary activity causes symptoms.
IV
Symptoms even at rest; any activity makes them worse.

Studies set their own limit — many outside heart failure leave out class III–IV, while heart failure studies may ask for a particular class. Check the class this study names.

Life expectancy

The study doctor’s estimate of how long someone is likely to live. Criteria use it so that people can stay in the study long enough for it to answer its question.

Childbearing potential

Able to become pregnant: from the first period until menopause, unless permanently unable to through surgery (removal of the womb, or of both ovaries or both fallopian tubes).

Criteria for people of childbearing potential usually ask for a negative pregnancy test and for contraception during the study and for a time after it.

Contraception

Ways of preventing pregnancy. “Highly effective” methods fail less than 1% of the time a year when used correctly — for example an IUD or an implant.

Criteria usually say which methods count and how long to keep using them after the last dose, sometimes for male participants too. Some studies accept a partner’s vasectomy if it was confirmed successful and that person is the participant’s only sexual partner.

Cancer (malignancy)

Malignancy means cancer. Criteria about another or earlier malignancy ask whether you have had a different cancer, usually within a set number of years.

Some are commonly allowed, such as treated skin cancers other than melanoma and early cancers removed completely — check the exceptions this study lists.

05

Study design

Phase
Phase 2
Primary purpose
Treatment
Allocation
Not applicable
Intervention model
Single group
Masking
None (open label)
Enrollment
10 participants (actual)

Study arms

  • Experimental
    Treatment arm

    This is a single arm study; the study arm include all patients participating in the study who will all receive Denosumab 70 MG/ML \[Xgeva\]

    Drug: Denosumab 70 MG/ML [Xgeva]

Interventions

  • DrugDenosumab 70 MG/ML [Xgeva]

    Drug page: Denosumab

    As already described in arm description

    Also known as: Xgeva

06

What researchers measure

Primary outcomes

  1. Primary efficacy endpoint: effect of denosumab treatment on the activity status of the disease (Incidence of patients with active disease)

    The primary efficacy endpoint will be measured through the incidence of patients with active disease at Month 8. Given that all patients have active disease at baseline the incidence of patients with active disease at Month 8 will provide the efficacy of denosumab in controlling the disease within this time frame.

    Time frame: 8 months

Secondary outcomes

  1. Secondary efficacy endpoint: development of disease-related permanent sequelae during the study period (Incidence of disease-related permanent sequelae)

    Incidence of disease-related permanent sequelae, developed during the study, at month 18. In specific, permanent sequelae such as diabetes insipidus, anterior pituitary deficiencies, and pulmonary failure will be assessed at the end of the study in order to evaluate the efficacy of denosumab in preventing those conditions.

    Time frame: 18 months

Other outcomes

  1. Safety endpoints: Incidence of all Adverse Events during the trial

    Incidence of Adverse Events during the trial. In specific, all adverse events will be assessed at the end of the study period in order to evaluate the safety issues of denosumab treatment in LCH.

    Time frame: 18 months

  2. Safety endpoint: Incidence of all adverse events on bone metabolism following Denosumab treatment and its withdrawal

    Assess the effects of treatment and its withdrawal on bone metabolism, in particular the presence or not of rebound of bone turnover following discontinuation of Denosumab

    Time frame: 30 months

07

Study locations

1 site
  • 251 Hellenic AirForce & VA General Hospital, Dpt of Endocrinology
    Athens, Attiki 11525, Greece
08

References and documents

Publications

  • Makras P, Tsoli M, Anastasilakis AD, Thanou M, Kaltsas G. Denosumab for the treatment of adult multisystem Langerhans cell histiocytosis. Metabolism. 2017 Apr;69:107-111. doi: 10.1016/j.metabol.2017.01.004. Epub 2017 Jan 12. PubMed 28285639 ↗
  • Makras P, Salagianni M, Revelos K, Anastasilakis AD, Schini M, Tsoli M, Kaltsas G, Andreakos E. Rationale for the application of RANKL inhibition in the treatment of Langerhans cell histiocytosis. J Clin Endocrinol Metab. 2015 Feb;100(2):E282-6. doi: 10.1210/jc.2014-2654. Epub 2014 Nov 6. PubMed 25375981 ↗
  • Makras P, Polyzos SA, Anastasilakis AD, Terpos E, Kanakis G, Schini M, Papatheodorou A, Kaltsas GA. Serum osteoprotegerin, RANKL, and Dkk-1 levels in adults with Langerhans cell histiocytosis. J Clin Endocrinol Metab. 2012 Apr;97(4):E618-21. doi: 10.1210/jc.2011-2962. Epub 2012 Jan 25. PubMed 22278426 ↗
  • Girschikofsky M, Arico M, Castillo D, Chu A, Doberauer C, Fichter J, Haroche J, Kaltsas GA, Makras P, Marzano AV, de Menthon M, Micke O, Passoni E, Seegenschmiedt HM, Tazi A, McClain KL. Management of adult patients with Langerhans cell histiocytosis: recommendations from an expert panel on behalf of Euro-Histio-Net. Orphanet J Rare Dis. 2013 May 14;8:72. doi: 10.1186/1750-1172-8-72. PubMed 23672541 ↗

Individual participant data

Plan to share: No

09

Timeline

Tracking since Sep 25, 2026
ElapsedEstimatedEstimated, not yet reachedSimilar studies: half by the dot; the band is the middle halfHalf of similar studies reached it by the dot; the band is the middle half, from a quarter to three quarters

Ran from Sep 2017 to primary completion in Jun 2022, 57 months.

Of 32 phase 2 interventional studies under Histiocytosis, Langerhans-Cell, half reached primary completion within 63 months of starting (the median), counting those still running; a quarter within 55 and three quarters within 85. This study's 57 months is close to that.

How these figures are worked out, and which studies are left out of them.

Registered
Aug 26, 2017
First posted
Sep 1, 2017
StartActual
Sep 7, 2017
Primary completionActual
Jun 22, 2022
CompletionActual
Jan 14, 2025
Last update
Jan 15, 2025
What these dates mean
Start.
When the first participant enrolled; while estimated, when the study expects to open to recruitment.
Primary completion.
When the last participant was examined or treated to collect data for the study's main question, its primary outcome. A study that stopped early gives the date its data collection stopped.
Completion.
When the last participant's last visit took place, for every outcome, secondary ones and side effects included: the end of the study. Often later than primary completion, sometimes the same day.
Actual and Est.
Actual means the registry says the date has happened. Est. (estimated) is a date the sponsor plans or expects. It can still move, and the sponsor is expected to change it to actual once it has passed.
No changes since tracking began. The registry record was last updated on Jan 15, 2025, before this site started recording changes on Sep 25, 2026. Its history is on ClinicalTrials.gov ↗
10

Registry details

Key details

Study ID
NCT03270020
Lead sponsor
Hellenic Society for the Study of Bone Metabolism
Responsible party
Sponsor
First posted
Sep 1, 2017
Start date
Sep 7, 2017
Primary completion
Jun 22, 2022
Completion
Jan 14, 2025
Last update
Jan 15, 2025

Study contacts

Polyzois Makras, MD, PhD
principal investigator · Dpt of Endocrinology & Diabetes, 251 Hellenic AirForce & VA General Hospital, Athens, Greece

Oversight

Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
View the source record on ClinicalTrials.gov ↗

Not currently enrolling

This study is completed, as verified in Jan 2025. You cannot join it, but the record below documents what was studied.

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