Xgeva

[Chris52981]

My dad is on lupron and Zytiga ( prednisone) and now Xgeva which I guess is a monthly shot - is it normal to have to get blood work monthly before the Xgeva and is that ever able to be given every few months rather than monthly ? Thank you!

[Chris52981]

Is a fullCourse forever or a certain amount of

Time

For

Xgeva

[Chris52981]

Yes he gets it every 4 weeks but I’m wondering if he will always be on it

[tango65]

They need to monitor blood calcium levels, since Xgeva could cause hypocalcemia.

accessdata.fda.gov/drugsatf...

[Tall_Allen]

I don't think he needs monthly blood work because of the Xgeva. It is more likely because his MO wants to monitor the effect of Zytiga + prednisone on his potassium levels. Low potassium and high BP are signals that he isn't getting as much prednisone as he needs to replace what Zytiga takes away.

For Xgeva, there is a risk of hypocalcemia, but it is most critical in the first weeks of initiating therapy. Once it is stable, it doesn't have to be monitored as often. If it is low, your father should be given calcium, magnesium, and vitamin D as necessary. Of course, there is no reason to start him on Xgeva at all unless a DEXA scan showed signs of osteoporosis.

I think you are asking a good question best posed to his MO. I remember how much my father hated being poked with needles all the time.

[Herman_PSA_OK in reply to Tall_Allen]

Greetings TA!

Went to the MO today and I'm getting started on the Zytiga + Prednisone as you suggested. 👍👍😀 Anyway, on the topic of Xgeva you wrote:

"Of course, there is no reason to start him on Xgeva at all unless a DEXA scan showed signs of osteoporosis."

My MO suggested I go on either Xgeva (Denosumab) or Zometa IVs once per month. My last bone DEXA density test was two years ago. When I asked him today for a DEXA scan to first check my bone density, he refused and said it is not important since I have one new bone met and that is all he needs to know.

When I asked him about side-effects while on Xgeva and approx. cost, he was trying to steer me towards Zometa once per month. He said, "no one has ever died from bad teeth jaw problems if there are complications with Xgeva which is rare, but if you break or fracture a bone from advanced PCa, you may possibility die or be worse off in great pain." Your choice.

He was surprised and pleased when he asked about my Medicare insurance coverage and if I had supplemental Plan-D which I do. His face just light up and in dollar $$$$ signs. I told him I would think about Xgeva and get back to him after I do more research with my support family members.

I'm going through all the HU post I can find on the subject. It sounds darn expensive even with Plan-D co-pays since it is a 5-Tier drug. He said, "If you find these treatment are too expensive, let me know and I will try to help you out."

I'm concerned about the combined SE being on ADT, Zytiga+Prednisone for the first time and on top of that Xgeva shots and sticker shock??? It would be interesting to hear from others on how it has impacted them.

Thanks again TA!

Herm

[Tall_Allen in reply to Herman_PSA_OK]

Here's a tool for calculating your risk of a fracture. You have to know your BMD and the DXA machine it was taken on.

sheffield.ac.uk/FRAX/tool.a...

If you are still hormone sensitive, the need for bone-protective therapy is less clear than if you are already castration resistant.

Because of financial toxicity, you can discuss cheap bisphosphonates instead.

[Chris52981]

Yes he had something with that due to I guess the lupron and bone mets - but the blood work thank God has been normal. He sees dr pannikar who fox chase recommended and he runs the oncology dept so he has. Great reputation and prolly knows what best I guess so I guess it’s good to

Be cautious!

[Chris52981]

Thank you everyone