Prolia

[tmpascale]

My last bone density scan indicated that I had osteoporosis in my neck and several areas of osteopenia. He wants me to begin Prolia injections. My on-line researchdoes not come up with anything positive about this drug. Does anyone here have any input on this?

[ctarleton]

The active ingredient in Prolia (as seen on TV) is the drug denosumab. It is typically given to postmenopausal women every 6 months to help prevent bone damage from their osteoporosis conditions. Another version of denosumab is used by oncologists for their patients with various more serious advanced cancers that are metastatic to bones. This form is called Xgeva, and it is an injectable drug, typically given every 4 weeks, and perhaps reduced to perhaps only every 12 weeks after a year or two. It is used to try to help prevent "skeletal related events", when bones may fail or break, etc. due to the cancer which has spread to bones.

Another bone agent often used by oncologists for similar purposes is IV Zometa (zoledronic acid). It is similarly used by oncologists in the context of bone mets from different types of metastatic cancer, with similar dosing schedules. Some health systems/oncologists may favor one drug over the other for cost considerations, or other reasons.

Ask your oncologist for more details about Zometa vs. Xgeva, and see what gets said.

Many of the posters here who have advanced prostate cancer with extensive bone mets have had one or the other of these drugs multiple times since getting their initial diagnoses.

Charles

[tmpascale in reply to ctarleton]

Thanks for the response and the info. So far, my bone scans have been negative for bone mets. The denosumab (Prolia) has been recommended solely because of the osteoporosis. My concern has been all the negative feedback I have seen on line.

[Tall_Allen]

The side effects are rare and are not likely to occur in the short term. It is excellent at preventing fractures.

[Ran2599dy in reply to Tall_Allen]

Please sight a reference!

[Tall_Allen in reply to Ran2599dy]

academic.oup.com/annonc/art...

onlinelibrary.wiley.com/doi...

[Ran2599dy in reply to Tall_Allen]

Interesting, but read the following study - Long-term effects of bisphosphonate therapy: perforations, microcracks and mechanical properties.

Not sure what to believe but microcracks bother me.

[Tall_Allen in reply to Ran2599dy]

You didn't include a link, but it looks like it's only a problem with long-term use. Fractures would bother me a whole lot more than microcracks.

[Ran2599dy in reply to Tall_Allen]

spiral.imperial.ac.uk/bitst...

[Tall_Allen in reply to Ran2599dy]

Thanks. You understand that this is based on 8 people who got bisphosphontes, and 7 were female. These drugs are sparing many men fractures and spinal compression. Zometa+celebrex has been shown to increase survival by 22% in metastatic hormone-sensitive men.

[Moespy in reply to Tall_Allen]

TA - Can you provide a link (or Links) showing the 22% Survival Benefit. Everything I am finding shows no OS benefit to adding Z & C. Appreciate it.

[Tall_Allen in reply to Moespy]

Here ya go:

ascopubs.org/doi/10.1200/JC...

i don't know what you've seen, but this was the only RCT I'm aware of for the combination.

[Moespy in reply to Tall_Allen]

Last paragraph of this report: "Our data show no evidence of a survival advantage in adding Cel alone for all men starting long-term HT for the first time. We previously also showed no evidence of a survival advantage in adding ZA alone for the same patient group. Overall, the combination of Cel and ZA had no effect".

Am I interpreting this wrong?

[Tall_Allen in reply to Moespy]

Yes, you are misinterpreting it. They are saying that when you include ALL groups in their STAMPEDE RCT, which included non-metastatic and recurrent patients as well as those with metastatic hormone-sensitive PC, the survival advantage was not statistically significant (although it was statistically significant for prostate cancer specific survival). But the combination of Celebrex and Zometa afforded a statistically significant 22% overall survival advantage among the sub-group of men with metastatic hormone-sensitive PC (see Table 3).

[Moespy in reply to Tall_Allen]

Excellent. I have Bone/Ct Scan in Mid-October and I have never been on ADT. Question: I assume I should discuss adding C&T to either Abi or Doxy/Pred depending on result of scan? Thanks for explanation. Jim

[Tall_Allen in reply to Moespy]

You would not take Zometa if you are not on ADT.

[Moespy in reply to Tall_Allen]

Deoending on result of the scans (number of and where Mets found) If I go on ADT along with either Abi or Doxy/Pred I would not take Zometa just Celebrex? Thanks again.

[Tall_Allen in reply to Moespy]

No - Celebrex on its own has no effect. What is Doxy/Pred - Docetaxel? You would only take Zometa if you are on long-term ADT. They will do a Dexa scan to determine baseline bone mineral density.

[Moespy in reply to Tall_Allen]

2nd Bio-Recurrence after RP in 2011 and IMRT in 2015. Never on ADT but will be after the upcoming CT & Bone Scan. The ADT will be in conjunction with either Docetaxel or Abiraterone/Prednisone depending on what and where the Mets see found on the scan. Would it be appropriate to suggest adding Zometa and Celebrex to either treatment or am I off base? Thank you for your assistance.

[Tall_Allen in reply to Moespy]

If you decide to go on ADT, you can discuss adding Zometa, Prolia or Xgeva to maintain BMD. If you have detectable mets, you can add Celebrex to Zometa (or Xgeva, probably).

[Moespy in reply to Tall_Allen]

Thanks TA, I will discuss with MO. Appreciate the info!

[Dan59 in reply to Ran2599dy]

Ran, I have been on biphosphonates zometa and xgeva for 12 years, I have not had any breaks and none of the side effects. Proper Dental care is needed, with no extractions or implants. I wish you the best.

Dan

[Hidden in reply to Dan59]

Hi Dan, I was wondering, over your 12 years of Xgeva, have you received an injection every 30 days or have they stretched it out a bit to 60 or 90 days? I have been on Xgeva for 9 months and am a little concerned.

[Dan59 in reply to Hidden]

When on zometa for 8 years I did it every 90 days under the advice of Dr Sartor, in a successful try to alleviate SE, of course Sartor already knew of a good study for doing so which is the advantage of an expert APC MO. On Xgeva/denosumab. I have argued for every 90 days , but they insist on every 30 days. Recently bcse of Dental work. (Crowns) being done I have stopped xgeva for 6 weeks prior to dental to 6 weeks after, but other than that mostly every month for last 3 years doing xgeva/prolia/denosumab.

Enjoy your day, I am headed out for a drive on a beautiful autumn day.

[j-o-h-n in reply to Dan59]

Autumn? It's still....

youtube.com/watch?v=lnXLVTi...(Not working as expected?)

Good Luck and Good Health.

j-o-h-n Friday 08/31/2018 6:41 PM EDT

[willshake in reply to Tall_Allen]

I get Zometa once a year and have been warned by my oral surgeon about necrosis. Had a tooth pulled two years ago. and need to have another one out soon. How rare is it?

[Dan59 in reply to willshake]

You will need to be off zometa for a period, before and after an extraction. and let it wash out of your system, I do not know exactly though when I was on zometa I stopped for three months before an extraction a few year back with no problem, and some time after. ONJ is not very fun, there are experts in treating it. It is always better to pay extra and have a crown put on as that is not so invasive as an extraction or a implant. TA will have more info than I. I suspect with once yearly you will be able to find a distant time from zometa infusion to have the needed extraction, if there is no other way.

[Tall_Allen in reply to willshake]

5% - It's higher the longer one is getting it. It's 7-fold higher in patients getting dental extractions. Amoxicillin may help prevent it.

[RyderLake2]

I have been on Prolia aka Xgeva (denosumab) for more than five years with no serious side effects. My medical oncologist prefers Prolia over Zometa (zoledronic acid) because he feels it is safer and more effective at delaying or preventing bone complications such as bone fracture. Denosumab is a drug that targets a protein known as the RANK ligand. This protein regulates the activity of osteoclasts (cells that break down bone). Denosumab has shown some very promising results in the management of bone metastases and treatment related bone-loss. Hope that helps!

[tmpascale in reply to RyderLake2]

Thanks for the response

[Schwah]

I am in a similar situation and I will be going with zometa and adding Celebrex. That’s because Tall Allen in his infinite wisdom pointed out to me that the latest studies showed that combination reduced deaths by 22%. I’m surprised he didn’t mention that again in his answer to you. They are not sure why it helps but who cares. Strengthen your bones and increase your odds at the same time. It’s a no brainer.

Schwah

[SUPERHEAT12]

Bone mets throughout the skeleton stopped with Xgeva. Started taking it 8 months ago. Last scan two days ago show no growth in the tumors. MO says I can ski again this winter. Have had virtually no side effects.

[tmpascale in reply to SUPERHEAT12]

Thanks

[Litlerny]

Thanks Tall_Allen, Dan59, and C Tarleton for sharing your insights and the valuable information. Prolia is very effective and has a low incidence of serious side effects. Probably the scariest potential side effect is osteonecrosis of the jaw, but that is very rare. Make sure you get any needed dental work done before starting on Prolia, and keep regular dentist visits.

[tmpascale in reply to Litlerny]

Thanks for the response

[Break60]

I had prolia injections while on ADT3 for 13 months to mitigate the impact of ADT on bones. I had bone density scans a couple times during the process and everything showed up ok. I had no side effects. Then six months later I had a bone met i had xgeva shots for 13 months. It did cause fatigue.

[tmpascale in reply to Break60]

Thanks for the response

[john205]

Look at this and ask if it applies to you. academic.oup.com/annonc/art...

[Beermaker]

I have been on Prolia for about 5 years now. Absolutely no problems, and even some unexpected benefits. Before the first Prolia shot, they gave me a Dexa scan which showed wide spread osteopenia. Then after no scans for 3 years, and Prolia shots every 6 months, I took a new Dexa scan. I was amazed that all the problems (osteopenia) had gone away. I had another Dexa scan this year, and still no problems. So I can recommend Prolia based on my personal experience.