Access, Monitoring, and Open Questions in TGCT Management

Dale R. Shepard, MD, PhD, of Cleveland Clinic, and Alexander B. Christ, MD, of UCLA Health, discuss practical management of tenosynovial giant cell tumor (TGCT) with R. Lor Randall, MD, FACS, of UC Davis Health. Dr Shepard says specialty pharmacies and manufacturer assistance programs, including bridge therapy, usually get patients started within weeks. He obtains a magnetic resonance imaging scan about 3 months into therapy but relies more on how patients feel than on tumor shrinkage. No trial has shown whether these drugs limit joint destruction, and Dr Christ suggests studying joint space and cartilage. For extensive disease behind the knee, Dr Christ pushes harder for systemic therapy. Both name treatment duration as the biggest open question, and Dr Shepard suggests pooled real-world evidence or a cooperative group study. Dr Shepard urges clinicians to learn what matters most to each patient, and Dr Christ to treat what most affects daily life.