NO has recommended 6 month Xgeva injections. Can not find that schedule anywhere. Longest I have found is 3 months.
Been for dental review and "all clear" . Yet, I fear the terrible SEs. All these bone drugs have same SEs ?? I
G=8, Orig PSA 68.5, Dana Farber in Boston ceased Lupron after 24 months with PSA of .05. Not rescheduled for 6 month visit. PSA then @ 1.8 AND metastatic in pelvic bone. Left there "care" and sought more patient oriented institution.
Placed on Zytiga+10mg prednisone and Lupron (Eligrd). Fine for 1.5 yrs with PSA of 0.05. Last 2 months PDA rose to 1.0.
Bone scan had reading of -1.9. Ergo, Exgiva recommendation.
Anyone had similar situation ??? And fears ????
Pls excuse my rambling. Any assistance is greatly appreciated.
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I have been on Xgeva aka Prolia (medical name denosumab) for over six years. I get the injection twice a year every six months. That is the normal maintenance dose to maintain bone strength. No side effects although my family doctor does like to do blood work to check kidney function prior to the injection. Xgeva (Prolia) is a Rank L inhibitor and one of the safest bone strengthening medications you can take. Good luck!
Jaw necrosis is rare at the start. Rare SEs aren't a reason to avoid. Fractures and spinal compression if you avoid can be crippling. The stronger the medication, the higher the dose rate, and the longer you've been taking it, the greater the risk of SEs.
Consider adding Celebrex - the combination of Zometa (a similar medication) and Celebrex increased survival by 22% in men with bone metastases.
I understand your concern. I am on xgeva 120 mg/1.7 ml every 28 days. I have had no side effects. My wife's rheumatologist has offered her Prolia every six months. Her concern is if she has any side effects the drug will be in her system for six months or more.
Ask your doctor if he would prescribe my dosage every 28 days.
The incidence of osteonecrosis of the jaw is low (around 1.9%, to 4%). It is more frequent after the first year. It is associated with teeth requiring extraction. it could be related to previous associated infection of the extracted teeth. These are fragments of an UPTODate review of medication related ONJ:
Medication-related osteonecrosis of the jaw in patients with cancer
Authors:James R Berenson, MDAlison T Stopeck, MDSection Editors:Robert A Kyle, MDReed E Drews, MDDeputy Editor:Diane MF Savarese, MD
Contributor Disclosures
All topics are updated as new evidence becomes available and our peer review process is complete.
Literature review current through: Jul 2019. | This topic last updated: Feb 21, 2019.
"INCIDENCE AND RISK FACTORS
Antiresorptive therapy — Although potentially serious, MRONJ is a relatively uncommon complication of therapy with intravenous (IV) bisphosphonates and denosumab among patients with advanced malignancy, although it is more common in patients with cancer than in patients who are treated with antiresorptive agents for osteoporosis [47]. (See "Risks of bisphosphonate therapy in patients with osteoporosis", section on 'Osteonecrosis of the jaw' and "Denosumab for osteoporosis", section on 'Adverse effects'.)
The best information on incidence in patients with advanced cancer comes from a review of data on 5677 patients with bone metastases from a wide variety of malignancies enrolled on three identically designed prospective randomized trials comparing zoledronic acid with denosumab for the prevention of skeletal-related events; the most recent data were presented in a preliminary report at the 2013 American Society of Clinical Oncology (ASCO) meeting and were updated with data from the open-label extension phase of the trials in breast and prostate cancer patients [40,48,49]. ONJ was defined per the 2009 guidelines of the American Association of Maxillofacial Surgeons (AAOMS) [50].
The following findings were noted:
●All patients were treated monthly, and the median time to onset of ONJ was 15 to 16 months [48]. Sixty-three patients (1.9 percent) on the denosumab treatment arm developed ONJ compared with 44 (1.3 percent) on the zoledronic acid arm. This difference was not significant between treatment groups (p = 0.08). The cumulative incidence rates of ONJ increased with longer duration of exposure, with an incidence of 0.7 to 1.4 percent during the first year of therapy and increasing to 2 to 3.4 percent with continued treatment beyond one year [49]. When compared with the risk for ONJ in the placebo arms of the prior IV bisphosphonate studies to prevent complications from skeletal metastases (range 0 to 0.19 percent [51-53]), the risk of ONJ was 50- to 100-fold higher with the use of modern high-dose monthly IV bisphosphonates (ie, zoledronic acid 4 mg monthly) [40].
●Dental extraction preceded the ONJ event in 63 percent of cases; 82 percent had jaw pain, and a coincident oral infection was present in 48 percent of cases. (See 'Dentoalveolar surgery' below.)
"Dose, duration, and type of therapy
"
Denosumab — As with bisphosphonates, dose, schedule, and duration of osteoclast inhibition are associated with ONJ risk in patients treated with denosumab. The approved dose of denosumab for prevention of skeletal-related events in patients with bone metastases from solid tumors is 120 mg subcutaneously every four weeks. At this dose, the risk of ONJ is consistently slightly higher than that seen with IV bisphosphonates, but the difference has not been statistically significant in any individual trial:
●In an integrated analysis of patient-level information from all three registration trials, which were conducted identically with the only difference being the tumor type (ie, breast, prostate, or other solid tumors), the risk of ONJ with denosumab was slightly higher, but the difference was not statistically significant (1.9 versus 1.3 percent, p = 0.08) [48].
●In a preliminary report of a phase 3 clinical trial comparing denosumab with zoledronic acid in patients with newly diagnosed multiple myeloma, 4.1 percent of patients receiving denosumab compared with 2.8 percent of patients receiving zoledronic acid developed ONJ after a median drug exposure of 16 and 15 months, respectively [67]. (See "Multiple myeloma: The use of osteoclast inhibitors", section on 'Denosumab'.)
●In the most recent meta-analysis of five randomized trials of denosumab versus bisphosphonates (which included the three registration trials plus two others, both of which used different dose/schedules of administration for denosumab and neither of which prospectively evaluated ONJ as an endpoint), the rate of ONJ was again higher with denosumab, but the difference was not statistically significant (1.7 versus 1.1 percent, RR 1.48, 95% CI 0.96-2.29) [51]. Nevertheless, ONJ rates were consistently higher among denosumab-treated compared with zoledronic-acid-treated patients from individual trials.
When denosumab has been administered at a significantly lower dose (ie, 60 mg subcutaneously every six months) for the treatment of postmenopausal or cancer therapy-related osteoporosis, ONJ rates are less than 1 percent for up to five years of therapy [68]. (See "Denosumab for osteoporosis", section on 'Adverse effects'.)
As with bisphosphonates, duration of therapy influences risk, although at least some data support the view that risk plateaus between years 2 and 3 [40,69]. As an example, in an analysis of the three phase III registration trials, the incidence of developing ONJ was 1.1 percent during the first year and 4.1 percent thereafter [48].
Having too much Xgeva especially while on ADT for a long time make jaw necrosis much more likely than the data says about normal rates for JN of maybe 3% without ADT. 2 doses of Xgeva per year is usually plenty while on ADT that causes bone density reduction. But I had 3 doses at 2 months apart about 2 years back as doc said I ought to have, and then got beginning of JN which was pain in lower jaw, and a dentist could poke a probe painlessly through small hole in skin and rub on a small patch of bare bone. So the hole on jaw skin had just begun. Such holes in skin can be 12mm dia, leaving dead patch of bone exposed. An Oral surgeon confirmed the dentist's finding. I stopped taking any more Xgeva. The jaw pain went away, hole closed, seemed like I acted quick enough to cease what was really no good for me in high dose.
Probably had plenty to last me to now, but I doubt any drugs used to stop bones thinning will also stop growth of Pca mets in bones as is so often claimed. Getting old and becoming unable to do exercise involving jumping up an down on hard surfaces is a main cause of low BD, and even elite young cyclists and young swimmers can suffer low BD. BD also lessens in astronauts
sent to spend months on space stations in weightless conditions.
Xgeva is used most often in patients with Osteoporosis so the literature is speaking mostly to those patients. I also had 6 month injections for two years of Xgeva when I was on Lupron. I had no side effects from Xgeva, except one day I fell in a parking lot and broke no bones. For that I am very grateful.
I’ve been on xgeva since 2017 when first bone met was discovered. Started with monthly shots. After bone density scans turned out normal I cut back to quarterly shots. I also work out daily with weights for bone strength. I’ve had no SEs.
I had my second 6-month Prolia=Xgeva shot a few weeks ago, and my usual ADT-related stiffness/creakiness may be a little bit worse. I expect with exercise, it will pass. I had my last 2 wisdom teeth extracted 4 months after my first shot (2 months for healing before the next one). I was not having any problems with the teeth, but figured I eventually probably would have, and better to have them extracted now rather than after I've been on Prolia for some years.
Good luck with the side effects. They probably won't be much.
Sorry, I don't know. I have had exactly 2 prolia SHOTS (not infusions), 6 months apart. Are you asking if one 6-month dose is equivalent to to six 1-month doses? I can probably find in my records how much was in each dose, if you like.
Xjeva every month for 2 and a half years. Had 50% T12 spinal compression fracture before diagnosis and start of treatment (getting up off of couch!). I do not lift anything heavy. Because I have many spinal bone mets, now "stable, with no new mets," I consider Xgeva to be the glue that keeps me together. Lupron and Xtandi and Celebrex now stare at the cancer cells that the chemo could not destroy. They will blink someday. But for now, I am having a lot of fun. Enjoy.
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Xgeva frequency ?
Xgeva and Bone Mets
One year since Diagnosis
XTANDI SIDE EFFECTS
