XGEVA , Dosing change?

Question. I've been receiving Xgeva injections every 4 weeks for about two years now. My MO says we're going to reduce that to every 3 months. I didn't get a clear explanation as to why. Any thoughts? Also I began Eligard every 4 months with daily Zytiga 1000 mg and prednisone 5 mg x2 daily in June 2019, my psa took quite some time to reach .24 and stay there, but lately it began dropping again. Is this normal? It's at .19 as of May 16. More importantly, weening off the Xgeva, what does that mean?

[Magnus1964]

My xgeva dose was changed also. My research doctor said after a few years it needs to be so to avoid side effects.

[Hidden in reply to Magnus1964]

Seems logical. Thanks

[Tall_Allen]

Xgeva side effects are cumulative. When trials ran for 2 years, it showed it made no difference. But longer trials seem to show that every 3 months is a waste of time. You may be better off with an Xgeva vacation, according to Fred Saad (an expert in this):

urotoday.com/video-lectures...

[Hidden in reply to Tall_Allen]

Thanks, is it true that stopping Xgeva cold, can have severe consequences regarding pathologic fracture?

[Tall_Allen in reply to Hidden]

FYI:ccjm.org/content/87/6/339

[Hidden in reply to Tall_Allen]

Interesting, now I'm thoroughly confused

[pjoshea13]

Tommy,

Just to give you an idea of the levels in your body:- the half-life of Denosumab [Xgeva] is 28 days, so you get down to 50% while on the 4 week cycle & ~12% on the 3 month cycle.

In time, approaching a steady state, the 28 day cycle begins with 100% (plus the new 100%), while a 3 month cycle begins with about 14% (plus the new 100%).

Perhaps not very helpful? LOL

-Patrick

[Muffin2019]

I was getting it monthly but went to every 3 months this year, it affects your teeth.

[SViking]

Dr. Dorf City Of Hope has me on a shot of Xgeva once every 90 days. She started that way and keeps me that way because she believes that Xgeva is much too strong to take every 30 days.

[ctflatlander]

Hi Tom. I've been on Xgeva since June 2019, 3month interval shot and also on ADT since 2017. My first Dexa scan in Feb 2018 was borderline ostopenia. Interesting my Dexa scan in April 2020 was borderline osteoporosis and recently in April 2022 my scan did a reverse and performed better than the test in 2018. The diet has not changed much but I have done a better job at the gym doing cardio and resistance training. The other change was switching calcium supplement from Citracal to Boneup which was done in April 2020. Has Xgeva helped? I'm very pleased with my recent Dexa but now have a jaw issue either osteoncrosis or tori bone. My dentist is prescribing an antibiotic and will see him in a couple weeks. I may have to see an oral surgeon. In any event I'm going to persuade my MO in June to stop Xgeva and possibly transition to another treatment. Bob

[Hidden in reply to ctflatlander]

Thanks for the info. My greatest fear is ONJ, as I needed 8 Extractions of all rear Molars/ Wisdoms that were sketchy due to "preventative" dentistry as a kid. I have a couple teeth that are suspect now, but am deathly afraid of ONJ if I get a dentist that doesn't understand denosumab.

[ctflatlander in reply to Hidden]

My dentist may not understand it either. The condition of my teeth and gums are excellent and my hygienist asks how I was brought up and I say it was the goats milk. If I have ONJ it's not because of my teeth. xgeva is the culprit.

[Hidden in reply to ctflatlander]

Oh for sure. I never heard of ONJ before I was prescribed Xgeva

[Miccoman]

90 days is more common than you suspect. I had to insist on 90 days with my new MO as he wanted it back to every 30, but I've been on either Prolia or Xgeva (same drug, different dosages) for 8 years, plus VA & in Europe 90 days is very common. He relented and I didn't even have to produce any research -- I like him in that he listens to me.