The standard approved dosage regimen for Xgeva is having an injection every 4 weeks. My Oncologist has been concerned about potential toxic side effects of this drug, such as necrosis of the jaw. As such, he has been treating me less frequently at 6 week intervals. I have been on this drug for several months, as I have metastasis to the pelvic bone.
Is anyone else taking Xgeva on a other than a 4 week treatment cycle?
Has anyone experienced side effects from Xgeva, and was it significant enough that you had to stop taking it?
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HopingForTheBest1
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My husband is on Xgeva has been taking it since mid September of this year. He had the shot while on chemo back in February and it drained all of his calcium that it put him in the hospital for a few days so he can get calcium treatment. So his oncologist wanted to wait to give him the Xgeva shot once his numbers were back up. She also wanted him to take calcium pills daily to help. She did mention that he could get nercrosis of the jaw but to check with his dentist regularly. He has to get the Xgeva shot once a month so far the only side affects he’s gotten is some light headaches
Yesterday, Fred Saad presented his findings that it is not a good idea to give Xgeva or Zometa less often. He recommends taking the full dose at recommended frequency for at least 2 years and re-assessing then:
The mechanism of action of Zometa and Xgeva are completely different. There are not data to support that adding Celebrex to Denosumab ( Prolia, Xgeva) could offer any benefit to a patient.
Celebrex is not a totally innocuous drug. It could be associated with cardiovascular, GI and renal problems.
They are "completely different" only in the way they achieve what they do, but they are very similar in their net effect - they are both osteoclast inhibitors, and decrease bone resorption. I cannot guarantee that Xgeva increases survival by 22% when added to Celebrex the way Zometa does, but it is a reasonable hypothesis.
Celebrex has much the same side effect profile as every other NSAID (like naproxen or ibuprofen). However, it has much milder GI effects, so it can be used much longer than other NSAIDs. It was developed for people with arthritis who take it every day for many years as a safer alternative. It has been used since 2004 in people who take it every day. I think it is worth those risks for a 22% survival increase, but everyone must decide for himself.
It could be higher when patients are old and have hypertension, or diabetes, or renal and/or coronary complications.
There are not data showing a benefit in the control of the cancer by adding Celebrex to denosumab..
IMHO it is not adequate to recommend adding a drug which could cause cardiovascular/renal complications without any evidence that it could have a benefit to the patient.. Remember: " Primum non nocere:. "First do no harm" .
The point is that the cardiovascular complication rate is actually lower than other NSAIDs. The PRECISION trial that looked into Celebrex vs other NSAIDs found:
"Compared with celecoxib, ibuprofen had more major adverse cardiovascular events (p < 0.05), and both ibuprofen and naproxen had more gastrointestinal (p < 0.001) and renal (p < 0.05) events." (2018)
So the cardiac risk of Celebrex is lower than the cardiac risk of alternatives like ibuprofen or naproxen. And the GI and renal risk is lower, which is why it has been safely used by millions of arthritic people since 2004.
I agree that when STAMPEDE looked into this, only Zometa was available for testing. So the results may not apply to Xgeva, which is also an osteoclast inhibitor. [Just as Zytiga and Xtandi have similar survival benefit, although they have differing modes of inhibiting the androgen receptor]. But it is a reasonable bet that it does apply.
So, if you want to forgo a chance at a 22% survival increase by simply taking it with a known safe drug, that is certainly your prerogative. I doubt most men would agree with you, however.
LOL!! - do you actually imagine I made that number up? I never make up stuff - this is about people's lives.. You can read it for yourself:
"Preplanned subgroup analyses in men with metastatic disease showed a hazard ratio of 0.78 (95% CI, 0.62 to 0.98; P = .033) for Standard of Care + Zoledronic Acid + Celecoxib"
Your insulting explanation, does not have anything to do with denosumab (Prolia or Xgeva) and celebrex. There are not data that adding Celebrex to Denosumab offers any advantage.
Yes, you are making those numbers up when you recommend to add Celebrex to denosumb.
I do not need you to translate anything to me, thanks for the offer.
It wasn't insulting- it was explaining something to someone who apparently doesn't know what the facts are. As I said from the very start - it may be different. (Just as it was possible that Zytiga and Xtandi might have had different effectiveness until the data showed they had similar effect.) But since the two drugs are similar in effect and Celebrex is relatively safe, why would anyone forgo the reasonable possibility of a 22% increase in surrvival? I hope you understand the point by now.
Thanks for showing that presentation. There is clearly still a lot to learn. Meanwhile, what I believe is this:
(1) there is no need for any bone strengthening agent for most men starting ADT, and if they continue to do do weight bearing exercise at the gym, there may never be any need for it.
(2) Bone strengthening agents should only be given when DEXA scans show there is osteoporosis. Similarly, bloodwork should drive calcium and Vitamin D supplementation.
(3) If there is osteopenia, increasing weight-bearing exercise may be sufficient.
(4) Estrogen patches may be enough to reverse osteoporosis. They also may be a good alternative ADT. And they mitigate hot flashes. We will get more clarity on the risks and benefits from the trials in the UK.
(5) Multiple therapies that include second-line hormonals, and systemic radiopharmaceuticals (Ra 223, Lu-177, etc.) may dictate more frequent DEXA scans.
(6) Jaw bone necrosis is a minor side effect, but increases with time on the drug - so Dr Saad's recommendation of max 2 years seems prudent.
(7) If one is taking Zometa anyway, take it with Celebrex (with safety monitoring).
I meant - the incidence is minor. The cumulative incidence for denosumab and zoledronic acid , respectively, was 0.8% and 0.5% at 1 year, 1.9% and 1.2% at 2 years and 2.0% and 1.4% at 3 years. Dr Saad's recommendation to reassess after 2 years, holds the incidence to under 2% (which I call minor). Compare that to the crippling effects of fractures and spinal compression.
My mother only had access at the time (25 years ago) to an oral bisphosphonate. She had a will to live until she suffered spinal compression and was no longer able to walk. After that, her quality of life was such that she declined all further therapy. To me, the certainty of delaying the first symptomatic skeletal related event is well worth the less than 2% risk of ostenecrosis of the jaw (which may be even lower with prophylactic dental work and good dental hygeine.)
One more lupron injection and we’ll stop after that since I am responding well to it but keep on taking cassdex and see him in 6 months no radiation nothing and haven’t done any
Listen to Fred Saad's presentation. He doesn't think it's OK to skimp on the dose. What are your DEXA scans telling you? Did you need it in the first place?
I'll have to look at my next bone density test. I've been doing well on lupron and Xtandi. Stage 4 , 8 years out at NIH.
Hey guy! I respect what you’re doing . I just had my first prolia shot due to osteopenia setting in . It has similar fear of jaw issues. Keep healing yourself and as always always keep. HopingForTheBest .✌️
I've been on a monthly dose of xgeva for 23 months. This month I asked my MO if this was still necessary and his opinion was that there should be no negative affect to go to 8 week intervals in my case at this stage.
Interesting... A quick internet search says this about that trial:
"During the course of the trial, denosumab has partially displaced zoledronic acid as the bone-targeted agent of choice, following the comparison with zoledronic acid that showed denosumab to be superior in delaying the first skeletal-related event.20 Whether the frequency of administration of denosumab can also be reduced is not known and, because the mechanism of action is completely different, with no accumulation of the antibody in the skeleton, the results from OPTIMIZE-2 and CALGB 70604 should not be extrapolated to the use of denosumab."
I switched from monthly to every three months after two bone density tests 12 months apart showed normal. Plus when I switched from SOCADT to estradiol Patches my risk of osteoporosis went down reducing need for bone protection.
😜😜😜. Sorry but I have been on the every 4 weeks now for 38 months as well as xtandi, can’t tell what side effects are from what. Tendon issues in both shoulders which has ran down into my hands. Don’t know if that counts or not. Hating this monster 😡😡
My father had to stop it as was draining calcium from body so fast he had keep getting calcium infusion -so they stopped him taking it, not sure what going happen going forward
my travels (34 months) with the PCa have included a monthly shot of Xgeva (once every four weeks). a recent visit to my GU Medonc in Houston had me asking if I for sure needed a monthly shot and his comment was most likely not. again we are trying to promote bone health and for sure there may be reasons to take it month but if your active and in good health then every three months should be good. just my personal view..... not a doctor! No issues taking xgeva monthly so its truly a person thing.
I have been on a 4 week regiment of Xgeva for almost 2 years without any side effects. You must have regular dental checkups and take 1200 mg of calcium with Vit D every day (600mg in AM and 600mg in PM).
Hi, after an orchiectomy my PSA dropped to undetectable and my bone mets dropped off. The new urologist I was assigned said the mets would return and I was put on the monthly Xgeva and daily Zytega routine. Due to liver conditions the Zytega was used intermittently. Finally to your point after 22 months of Xgeva I underwent surgery to fix disk herniation. Afterward the surgeon said I had bone spurs on the spine (osteoarthritis). This is listed as a remote chance in the Amgen literature. And persons I've spoke to said it doesn't prove Xgeva caused the osteoarthritis. Hmm, Let's see no osteoarthritis before Xgeva and after 20 months increased spinal pain - osteoarthritis of the spine! Warning, the half life of Xgeva is 10 years. So it will take me 30-40 years of living to remove this SH&*. Thanks Amgen! PSA undect, mets 0.
Gentle folks, don't let them make us scared of dying! No one wants to die, but we all will! Celebrate the life we have and have had, the love we have around us! Don't let the inevitable have any sting!
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