Denosumab vs Celebrex and Zometa

[snoraste]

I discussed the Celebrex + Zometa combo with my MO (in the context of ~20% lower mortality rate in metastatic setting), and he suggested I take Denosumab (no Celebrex). I see studies comparing Denosumab to Zometa, but I don't see anywhere comparing it to the combo of Celebrex and Zometa, or used by itself in a combo. My MO is sort of open to my choice of the two. Any thoughts?

[Tall_Allen]

They only studied Zometa±Celebrex. The combination of Xgeva and Celebrex has never been tested but may work similarly. Zometa has consistently shown no survival advantage when used alone. I assume the same will be true for Xgeva. Why wouldn't he prescribe Celebrex for you?

[snoraste in reply to Tall_Allen]

I did not ask. I'm sure he'll be open to it. I though because the mechanism of action (as I understand it) is different between the two (RANKL inhibitor vs bisphosphonate), Celebrex perhaps is not needed?

[Tall_Allen in reply to snoraste]

Celebrex is only needed to extend survival and to reduce inflammation . I have no idea if the mode of action makes a difference for survival when combined with Celebrex , but I can’t think of a reason not to unless NSAIDs are a problem for you.

[dvcarola2 in reply to Tall_Allen]

Hi TA, what is the usual dose of Celebrex when combined with Zometa? I might ask our onco if he can give us a prescription for Celebrex, although my husband is no Xgeva and not Zometa.

[Tall_Allen in reply to dvcarola2]

Email him this:

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

[PhilipSZacarias in reply to Tall_Allen]

NSAIDS may be contraindicated for people with cardiovascular co-morbidities? Cheers, Phil

[Tall_Allen in reply to PhilipSZacarias]

It's rare, but it happens, even with ibuprofen.

[snoraste]

This is a good summary:

nature.com/articles/s41391-...