Xgeva / calcium & vitamin D.

[pjoshea13]

New anecdotal paper.

Part of my wife's treatment for solitary plasmacytoma is Xgeva every 3 months. She was told to use a calcium supplement, & the oncologist regularly monitors blood levels.

It's common knowledge these days that calcium alone does not guarantee bone health, & that vitamin D is needed also. (& other things too, that have been discussed elsewhere - particularly vitamin K.)

But some here are against supplementation with vitamin D, so the following is a heads-up for those who might be on Xgeva down the road.

"Denosumab is a monoclonal antibody that has been widely used for the prevention of skeletal-related events in patients with cancer with solid tumours and bone metastases, and acts by reducing the release of calcium from bones into the bloodstream. Severe hypocalcaemia is a rare and dangerous side effect of denosumab. We present a case of a patient with metastatic prostate cancer who developed severe hypocalcaemia after receiving a single dose of denosumab. Further laboratory analysis showed that the patient had a low vitamin D level, which contributed to the development of hypocalcaemia. He required an inpatient admission for repeated doses of intravenous calcium." [1]

Ideally, one's oncologist would monitor calcidiol levels (25-D) if administering Xgeva. (& those supplementing with cholecalciferol for PCa, will already be aware of their calcidiol status - ?)

-Patrick

[1] ncbi.nlm.nih.gov/pubmed/305...

BMJ Case Rep. 2018 Dec 13;11(1). pii: e226727. doi: 10.1136/bcr-2018-226727.

Severe hypocalcaemia following denosumab in a patient with cancer with vitamin D deficiency.

Watthanasuntorn K1, Abid H1, Gnanajothy R2.

Author information

1

Internal Medicine, Bassett Healthcare Network.

2

Hematology/Oncology, Bassett Healthcare Network.

Abstract

Denosumab is a monoclonal antibody that has been widely used for the prevention of skeletal-related events in patients with cancer with solid tumours and bone metastases, and acts by reducing the release of calcium from bones into the bloodstream. Severe hypocalcaemia is a rare and dangerous side effect of denosumab. We present a case of a patient with metastatic prostate cancer who developed severe hypocalcaemia after receiving a single dose of denosumab. Further laboratory analysis showed that the patient had a low vitamin D level, which contributed to the development of hypocalcaemia. He required an inpatient admission for repeated doses of intravenous calcium.

KEYWORDS:

Cancer - See Oncology; Cancer Intervention; Prostate Cancer

PMID: 30567243 DOI: 10.1136/bcr-2018-226727

[NPfisherman]

Thanks, Patrick....

[j-o-h-n]

To D or not to D, That is the question...Whether 'tis nobler in & etc.

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 12/22/2018 12:41 PM EST

[pjoshea13 in reply to j-o-h-n]

If you don't want "to suffer the slings and arrows of outrageous fortune", "'tis nobler" to take the D.

-Patrick

[monte1111 in reply to pjoshea13]

Restarted "The D" because of one of your earlier posts. I already have so many arrows in me friends are calling me General Custer. Thanks for all you do Mr. Patrick.

[JimVanHorn]

Thanks for the articles above. I was on Losartan 100mg for Blood pressure for years, recently my kidney creatinin was 5.1. My doctor cut my Losartan in half, and gave me Sodium Bicarbonate and corrected my diet and my creatinin is down to 3.5 (which still is high). I have other doctors who kept saying "Losartan is renal protective" but in the elderly with renal disease it can cause problems, now I have an article that suggests that.

I had Lupron for 6 1/2 years with Xgeva (one shot every 6 months) for 1 1/2 years. I was taking 2000 IU Vit D3 daily and now I am off all cancer meds and my PSA is 0.00 for 6 months. However, I noticed my Vit D3 level remained at 3 ng. So my storage of Vit D3 was gone and they are giving me 50,000 Units of Vit D3 (on prescription) once a week for 13 weeks to rebuild my storage. Hope you and your wife have wonderful Christmas.

[tallguy2]

It is for this reason that I like Prosteon, a calcium/mineral supplement with 2000 units of Vitamin D that's specific for men on ADT. I get it via mail order.