Tenosynovial giant tumors (TGCTs) are rare tumors that affect your joints. They are usually benign, which means they are not cancerous. The most common treatment for TGCT is surgery, but surgery isn’t always the right choice for TGCT. Your doctor might recommend a different treatment.
Are There Other Treatments for Tenosynovial Giant Cell Tumors?
There are some situations when surgery is not the best way to treat TGCT. Your doctor might rule out surgery to remove the tumor because:
- You have existing health issues, like some chronic diseases, that might make surgery risky.
- It might be hard to reach the tumor, or surgery could damage surrounding tissue.
- There may be a higher risk of joint stiffness and limitations, especially on weight-bearing joints.
- The tumor keeps coming back (are recurrent).
When this happens, your doctor may want to try nonsurgical treatments.
Which Medications Can Treat Tenosynovial Giant Cell Tumors?
Doctors can use some drugs to try to shrink a TGCT. These drugs are called targeted therapies. The medications are developed to specifically target certain cancer cells.
Pexidartinib
In 2019, the FDA approved a drug called pexidartinib (Turalio) for adults with a TGCT. It was the first FDA-approved drug for this type of
tumor. Pexidartinib is only available only under a restricted distribution program called Turalio REMS (Risk Evaluation and Mitigation Strategy) program. This means that doctors who prescribe pexidartinib have to have special training and certification.
Pexidartinib comes in a capsule that you take by mouth, usually twice a day. You shouldn’t open the capsule. If you have trouble swallowing it, speak to your pharmacist and doctor. They have some ideas to help you, or you may have to switch treatments. Do not eat grapefruit or drink grapefruit juice while on pexidartinib, and avoid antacids 2 hours before and 2 hours after your dose.
The most common pexidartinib side effects include:
- Burning, tingling, and numbness in your hands, arms, feet, or legs
- An overall sensation of pins and needles
- A change in how you taste things or loss of taste
- Changes in your bowel habits
- Changes in your hair color
- Stabbing pain
- Eye swelling
There are several drugs that you shouldn’t take or should be taken with caution if you need pexidartinib, so make sure your doctor knows all drugs and supplements you take beforehand. The list is long, but here are a few examples:
- Carbamazepine
- Clarithromycin
- Diltiazem
- Erythromycin
- Fluconazole
- Methotrexate
- St. John’s wort
- Valproic acid
- Verapamil
Imatinib
Imatinib (Gleevec) is a drug used to treat certain types of cancer, such as leukemia. Some doctors are using it “off label” to treat TGCT because it may shrink the tumors in some patients. Like pexidartinib, imatinib interacts with many medications, so be sure your doctor is aware of all medications and supplements you take before starting treatment.
Imatinib comes in a once-a-day tablet that you shouldn’t crush or break. If you have trouble swallowing it, ask your pharmacist if you can dissolve it in a glass of water or apple juice. Don’t eat grapefruit or drink grapefruit juice while taking imatinib. Don’t handle broken or crushed tablets with your bare hands. If you do touch them, wash your hands right away with soap and water.
This medication has several side effects. The most common ones include:
- Increased stomach acid
- Burping
- Changes in your bowel habits
- Feeling discouraged
- Being irritable
- Feeling bloated
- Muscle stiffness
- Night sweats
- Weight loss
Nilotinib
Nilotinib (Tasigna) is another drug used off-label to treat TGCT. It’s usually used to treat leukemia. Nilotinib comes in a capsule, which you shouldn’t break or crush while taking. If you have problems swallowing the capsule, ask your pharmacist if you can sprinkle it on some applesauce (it’s not recommended that you put it on other foods).
There are many side effects from this medication. Some of the most common ones include:
- Back pain
- Feeling itchy or having pain in areas where there is a lot of hair
- Diarrhea
- Joint pain or swelling
- Weakness
- Difficulty moving
- Pus at the root of your hair
Clinical trials
Researchers use clinical trials to look for new and better drugs and other therapies to treat TGCT. For example, some researchers are studying the drug vimseltinib as a TGCT treatment. Studies are showing positive results so far. Because vimseltinib is an investigative drug, it isn’t yet approved by the FDA.
If you are interested in being part of a clinical trial, speak with your doctor to see if there’s one near you that you qualify for.
Does Radiation Therapy Treat Tenosynovial Giant Cell Tumors?
Radiation therapy, often used to treat tumors, is another possible treatment option for TGCT. It can be used before surgery to shrink the tumor to a more manageable size or instead of surgery.
However, it’s uncommon to use radiation therapy now for this type of tumor. There aren’t many studies to prove that it’s helpful, and doctors are worried that possible risks of complications, such as joint stiffness, joint damage, fibrosis (thickening or scarring of the tissue), and a higher risk of a later cancer caused by the radiation, outweigh the benefits.
There are two types of radiation therapy that doctors have used to treat TGCT: external beam radiation and radiosynoviorthesis.
External beam radiation
This is the type of radiation therapy most people think about when they hear "radiation treatments." For this treatment, a radiation beam is delivered directly to the area where the tumor is. Getting radiation therapy isn’t all that different from getting an X-ray, but it takes longer – about 15 to 30 minutes for each session. You’ll lie down on the treatment table and the radiation therapist lines up the beam to the spot where the tumor is. Then, you’re asked to lie still as the radiation therapist starts the machine. Once the treatment is done, you can leave.
Radiosynoviorthesis
This type of radiation treatment involves injecting radioactive material directly into the tumor area. Research shows that patients who have radiosynoviorthesis are at higher risk of developing serious complications like early-onset arthritis and osteonecrosis.
Embolization
Tumor embolization, a procedure where a doctor blocks a blood vessel so it can’t supply a tumor with oxygen and nutrients, causes some tumors to stop growing, shrink, or die. It is another option for some people with TGCT. Your doctor may choose a tumor embolization if you can’t have surgery.
Watchful Waiting
Watchful waiting, or active surveillance, is one other option for people with a certain type of TGCT called diffuse-type TGCT that are asymptomatic. This approach is used for different types of tumors and cancers. If your doctor suggests watchful waiting, you won’t be getting any active treatment, like medications or radiation therapy, but you will be watched closely to see if your tumor changes or grows.
Over half of people with TGCTs get them again. So no matter what type of treatment you get for TGCT, there is a good chance that the tumor will come back. Regular follow-ups with your doctor can help you find them in the earlier stages.
Show Sources
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SOURCES:
American Cancer Society: “Targeted Therapy,” “Getting External Beam Radiation Therapy.”
Cancer Treatment Reviews: “Best clinical management of tenosynovial giant cell tumour (TGCT): A consensus paper from the community of experts.”
Cleveland Clinic: “Tenosynovial Giant Cell Tumor.”
European Journal of Surgical Oncology: “Active surveillance of diffuse-type tenosynovial giant cell tumors: A retrospective, multicenter cohort study.”
Frontiers in Immunology: “Update on Tenosynovial Giant Cell Tumor, an Inflammatory Arthritis With Neoplastic Features.”
Journal of Health Economics and Outcomes Research: “Surgical Treatment Patterns, Healthcare Resource Utilization, and Economic Burden in Patients with Tenosynovial Giant Cell Tumor Who Underwent Joint Surgery in the United States.”
Mayo Clinic: “Pexidartinib (Oral Route),” “Imatinib (Oral Route),” Nilotinib (Oral Route).”
Memorial Sloan Kettering Cancer Center: “MSK ASCO 2024 Research Roundup: Practice-Changing Advances in Head and Neck Cancer, Tenosynovial Giant Cell Tumor, Kidney Cancer, Lung Cancer, and More.”
National Cancer Institute: “Imatinib Mesylate,” “Watchful waiting,” “Embolization.”
Nationwide Children’s: “What Are Tenosynovial Giant Cell Tumors?”
OrthoInfo: “Giant Cell Tumor of the Bone.”
TGCT Support: “Medication,” “Imatinib.”
FDA: “DA approves pexidartinib for tenosynovial giant cell tumor,” “REMS Prescriber Certification Requirements.”
