Hi Folks 
We received a notice from our local oncologist that Elgie would now be receiving Zometa infusions instead of Xgeva due to the cost. They say it is the same quality at a lower cost. Does anyone have experience or does anyone know if this is true?
Thanks so much 
Jackie
I think the two are pretty much equal in terms of how effective they are and the risk of osteonecrosis of the jaw. Xgeva is a shot vs. Zometa which is an infusion so Xegeva is easier to administer. Xgeva did show an improvement over Zometa in a study with breast cancer, but the problem is cost/benefit. From what I've read, the benefit, if any is very small and doesn't justify the cost.
Thanks so much Gregg It's always scary when they switch things around due to costs. Xgeva worked so well for Elgie. I'm even wondering if it's something he still requires. We'll have to discuss this with the doc soon.
Very appreciative for your reply
Jackie
Hi Jackie, I have been on Zometa by 3 monthly shots since Jan 12, 2015. Most recent was last week. No problems other than standard mood swings (controlled after 3 months), shrinkage of male parts, loss of libido but not desire. They say all feminising returns to normal after you are cured but I did point out I am incurable so no chance! There's a lot of research at present on whether or not Testosterone is really the naughty one that must be suppressed. Maybe it isn't. Check with your Onco. All the best and God Bless. David
Hi again Jackie. I shouldn't sit in bed and try to write using my mobile. I confused Zometa with Zoladex. As you have been advised take Zometa in tablet form. Its half life is half that of the infusion which I had during 8 months of chemo. This presented with a serious problem when I had a tooth problem. Jawbone Death AKA ONJ. Hopefully my prob will be sorted next week. My dental/oncology specialist (6) have planned the treatment and hopefully I will be writing properly from my laptop and not trying to tap keyboard with something stapled to my chin. The infusion can last in the bones for 11 years.
I so much hope your tooth issue will be resolved with little to no pain David. You made me giggle out loud lol.
That's crazy the difference in pill and infusion. I am wondering how we go about trying to stay on Xgeva.
Thanks so much for your reply.
Jackie
Dear Jackie,
I can not comment on the drugs. Just wanted to send you a note saying the two of you are still in my prayers.
Clinical trial showed bone complications occurred 8.2 months later with xgeva than with zometa. 27.7vs 19.5 months.
Hi, I have been using zometa "bone strengthening med" for almost a year, but I have recently stopped until I have a root canal and a crown put in, I was suffering from a bad tooth cavity sore gum, I am ok now and will probably start taking zometa again, I don't know if it is my imagination or not but I thought that the overall chemo hell week was not as bad when not using zometa
so it was my impression that zometa contributes to the awful side effects of chemo.....
peace be with you.
Here's a quote from the article in the blog post:
1- Compared with zoledronic acid, denosumab significantly increased the median time to first SRE (20.7 months vs. 17.1 months; 18% risk reduction, p=.008) and had a similar benefit in the multiple event analysis.
2- They found that there were no significant differences between the treatment arms in median PSA over time, overall disease progression, or overall survival.
Sorry, but I don't agree that this is a significant improvement, especially when you consider that the price is around 2X for Xgeva. As consumers, we do have to consider cost vs. benefit even if "the insurance company is paying" because ultimately we are all paying for the high cost of medical care. Drugs that significantly raise medical cost while providing a negligible improvement should be questioned. We should make them earn their money and price the drugs in accordance with the benefit provided rather than rewarding them with a huge price differential for minimal benefit.
One caveat: "Denosumab may have an advantage over zoledronic acid in patients with renal insufficiency and may be a viable option in those who are unable to tolerate zoledronic acid." (see article below) In these cases, I believe that insurance would cover Xgeva.
Here's an article on the subject:
ascopubs.org/doi/full/10.12...
Thank you Gregg
Background: I have used both Zometa (2011) and Xgeva (2016-2017). The issue triggering these treatments was osteoporosis accompanied by evidence of high bone resorption, based on high serum C-telopeptide (CTx). The osteoporosis (T-score -3.73) was likely caused by ADT in 2009, and so far I am not having to deal with bone mets.
After using both of these drugs and monitoring the response of bone turnover markers, I have observed that (1) both drugs have a dramatic effect in immediately lowering CTx to 50-70 pg/mL; (2) the persistence of this effect appears to be a lot longer with Zometa than with Xgeva.
Of course, one patient's experience may not be representative of what most will see, but it's possible. If so, that would potentially give Xgeva a significant advantage for those concerned about osteonecrosis of the jaw (depending on how the drug is administered). See this study by a group of dentists who concluded that CTx < 100 pg/mL correlates with high risk for ONJ and CTx < 150 correlates with moderate risk, but CTx > 150 correlates with minimal risk: sciencedirect.com/science/a...
Following a 5 mg infusion of Zometa in 2011 it took 40 months for my CTx to return to > 150. In contrast, with 120 mg the CTx nadir was similar but the recovery to > 150 took just 4 months. One conclusion I reached was that for my circumstances, a dose of 60 mg Xgeva made more sense. Again, I am not dealing with bone mets, and your experience may be very different. But I like the ability to avoid a multi-year period where my CTx, according to one study, represents a sharply higher risk of ONJ.
One caution about lab variation in reporting CTx results: Most of my CTx labs came from LabCorp, but they recently made a major change in their analytical method for this test, at least on the West Coast. Because of this their results no longer bear any relationship to their prior results (even after adjusting for the change in reference range), and their new results also do not correlate with Quest CTx results. As a result, I have switched to Quest for this test.
Dave
We have been so very pleased with Xgeva Joel. Any way to keep it besides paying for it?
Thanks so much. Hoping you are doing well
Jackie
Hi everyone-just interested in knowing if anyone has used miloxantrone chemo & what they think of it - my husband Mike is on jevtana chemo right now - he's at the end of the line for approved medications - he's had radiation, taxotere, Zytiga, xtandi, Provenge, and now the jevtana chemo - what's next we don't know - maybe some clinical trials- hopefully. Any suggestions
Penny and Mike in Florida
As far as chemotherapies go, I heard of one person who tried Mitoxantrone and it worked when all the other chemos didn't. That's hardly convincing evidence, but if I was in that situation that's what I would probably do. Mitoxantrone used to be the main "second line" chemo for prostate cancer before Jevtana. You only have to commit to one cycle. If it doesn't work you can stop.
In many cases, Carboplatin is added to Jevtana. "platinum based" chemos are effective in killing cancer cells that are neuroendocrine and do not have androgen receptors. This kind of cell is generally rare in prostate cancer, but prostate cancer that has evolved during long treatment times with ADT often develops the characteristics of neuroendocrine cells.
Here's one article about using Carboplatin with Cabizitaxel (Jevtana).
sciencedaily.com/releases/2...
You can also do genetic testing to see if there are any mutations that will allow targeted treatments.
And of course there are clinical trials.
This is just my opinion and I'm not a doctor. You should discuss all of this with your doctor of course before doing anything.
Penny Sue, Mitoxantrone will provide palliation or pain relief. Find a good oncologist who is familiar with both prostate and breast cancer treatments and push them to play with some of the breast cancer chemotherapies. Some men do get a result from these non-approved prostate drugs. Also, ask the doc about a clinical trial, or go to clinicaltraisls.gov and search for one.
Joel
The risk of osteonecrosis of the jaw is about the same for Zometa vs. Xgeva according to at least one study. I can provide a link if anyone is interested.
I guess that's a great thing Gregg
The risk is fairly low and that's a good thing. I had an appointment with my doctor on Friday and we discussed these same bone strengthening meds. I'm not taking them now. She told me that was fine, but she is certain that I will need to be taking them sometime in the future.
Before starting any of these drugs, it is a good idea to go to your dentist and have a complete check. Do any and all work on your teeth before starting these drugs. This will minimize the need to have work done after you have started the drugs.
Deciding to end some treatment or all treatment of cancer is a huge thing to face. I found once I know all options for treatment with some quality of life have been tried and all options have failed, I know my decision to stop is the right one; it lets me live my remaining days with a measure of peace.
Another QUESTION :)))
Is this something .........The Xgeva ......that does not need to be continued if it has done its job....or is it a lifetime medication once you have had radiation and HRT? Just another question in my mind.
Jackie
Another QUESTION :)))
Is this something .........The Xgeva ......that does not need to be continued if it has done its job....or is it a lifetime medication once you have had radiation and HRT? Just another question in my mind.
Jackie
If you have active bone mets, (and especially lots of them, or lots of related symptoms) oncologists will likely put a patient on either Zometa (zoledronic acid) as an IV every 4 weeks, or on Xgeva (denosumab) subcutaneously every 4 weeks. The treatment typically continues indefinitely, not just a "one off" and done.
For Full Prescribing Information, and lots of background info, see:
pharma.us.novartis.com/prod...
pi.amgen.com/united_states/...
Overall Survival is roughly similar. The time to a skeletal related event might be a bit better with Xgeva, but an individual's mileage may vary.
I've known men who have been on Xgeva for years.
I, myself, (with extensive bone mets) got Zometa for 29 months in a row, then backed it off to every 90 days.
(There's not really a lot of science for usage beyond 24 months. Some folks back off the frequency of the drugs to 90-120 days if they are long term survivors with stable mets and no symptoms. Women with menopause-related osteoporosis risks, or non-metastatic breast cancer patients on aromatase inhibitors, sometimes also take Zometa. Xgeva for women may also come in a different form often advertised in magazines or on TV as Prolia.)
Charles
Oh thank you so very much Charles! You answered everything I was even wondering I guess you and Elgie may be the new statistics in science because you're both longer than 3 years for either Xgeva or Zometa. Elgie has been doing Xgeva every month to now every 3 months for some time now.
Thanks so much.
Jackie
Xgeva
Zometa
Xgeva time---osteoporosis
Zometa for strengthening bones
