Denosumab related osseous sclerotic response in metastatic s
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A 56-year-old female with a 38 pack-year history of tobacco use presented with a nonproductive cough, severe back pain, anorexia and weight loss. A CT scan of the chest revealed a confluent right hilar and mediastinal mass. Bronchoscopic biopsy confirmed small cell carcinoma of the lung. MRI of the lumbar spine demonstrated several bone metastases. She began chemotherapy with etoposide and carboplatin with pegfilgrastim (Neulasta) prophylaxis. Additionally, denosumab (Xgeva) was initiated for osseous metastases. After initiation of chemotherapy, the patient had significantly decreased pain and reduced cough with complete resolution of her primary pulmonary mass, but she developed sclerotic lesions after denosumab therapy.

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