My husband is now castrate resistant, with extensive progressive bone mets. He will be starting Jevtana unless the Lu-177 expanded access opens up soon. His MO also wants him to start Xgeva, but our insurance pushed back and wants him to use the less expensive Zometa. This surprised me, as we have never had any issues getting everything covered.
Thoughts on this? Should we try to push through approval or is the Zometa ok? Looking at clinical trials, it appears Xgeva has advantages.
Has anyone else had luck with commercial insurance?
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leebeth
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Zometa should be taken as a 4mg infusion every 3 weeks. 120 mg of Xgeva is given subcutaneously every 4 weeks. In the original comparative trials they gave Zometa every 4 weeks, and Xgeva appeared to work slightly better. But when it was given every 3 weeks it was found to work exactly as well.
Ask for celebrex with it (it helps with bone pain). In a trial of metastatic hormone-sensitive men, the combination (but neither alone) improved survival by 22%.
Also a good idea to start with a baseline DEXA scan to track bone mineral density.
Thank you. Great info. Since he is still working, every 4 weeks would certainly be easier. I would guess it should not be given on the same day as the chemo? He had a DEXA right after initial diagnosis, May of 2021, so that should be sufficient?
Idk if Zometa can be infused while he is already in the hospital for Jevtana. That would certainly be more convenient. His oncologist may want to discuss that with the manufacturer to determine whether any contraindications have come up during post-marketing.
You can email this to the oncologist about adding Celebrex:
The important results is: "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 SOC + ZA + Cel."
I used Xvega for about a year , until I started getting constant pain in my jaws . I went to my dentist and he noticed that jawbone was receding near one of my implants. He wanted to remove the implant. I went back to the dentist who had inserted the implants for a second opinion. He advised against it and asked what medication I was taken because he diagnosed the receding jawbone as osteonecrosis . It turned out that is one of the known side effects of Xvega . So I stopped using it ( 4 years ago ) .So just my experience, hope your husband doesn’t get this.
My brother developed osteonecrosis from Zometa. He is able to control it with a mouthwash. He was followed for some time by an oral surgeon who specializes in ONJ. It’s a known risk, but with my husband’s level of metastatic burden, the benefits outweigh the risk. I hope yours is stable!
I’m seeing an oral surgeon in the Erasmus University Hospital in Rotterdam, the Netherlands, every six months, he advised me to rinse with salted water. It’s been stable as well ! I discussed quitting the Xvega with my MO, he told me that the quality of life ( no pain in my mouth) would probably outweigh the benefits of Xvega. “ Just be careful, no mountainbiking , contact sports or anything where you can break a bone” . It’s been so good so far for 4 years, even with the metastases in my bones. Which are painful, but nothing a daily dose of oxycontin can’t fix.
You wouldn't believe how many times I say excuse me Ma'am, excuse me Sir, every day. I do Mindless Meditation. Sounds like you are Popsicles over there. Bet the cold cuts down on the crime and rats.
Was cold yesterday.....snow from Friday that froze to concrete consistency is mostly gone today..... I hate snow!!! Crime and the rats are one and the same....At one period of my life I used to meditate quite often, that's when I was having sex with the ex... I finally finished with redoing my kitchen floor. Removed very old layerS (100 years I guess) of linoleum, sanded the floor four times (manually) stained and polyurethane it. Looks fairly good....
Sex With the Ex. Sounds like a Netflix series. Still can't believe you did that kitchen by yourself. Congratulations. You have grit. Nothing good under my linoleum. I hope polyurethane doesn't cause cancer.
My husband had a horrible reaction from Xgeva. It came in severe bone pain in his hip where the cancer is at. Within two days of the injection he could not walk. Nothing relieved the pain. He is having a pain pump put in this week. Pain is slowly improving but he now has to use a walker. Our doctor said he has only seen it one other time in one of his patients. Good luck, I hope your husband has an easy time with it.
I've been on Xgeva for two years. I get a shot every three months. My insurance covered it, then last June I joined Medicare and it is still covered. With insurance companies, make sure each shot gets pre-approved. My provider forgot to, and I'm not sure they ever got paid.
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XGEVA 
Timing of XGeva & Radium 223. 
Starting xgeva next month
Prolia or Zometa
