Xgevia for osteopenia?

[rsgdmd]

So, I am recently diagnosed with stage IVb; largest mets are L shoulder blade and posterior 9th rib. Smaller in 3 other ribs and ischium. On DEXA, only femur neck numbers were low, -1.1 and -1.6.

Dr. put in for Prolia, twice yearly. Insurance will only cover for Xgevia, 4 X a year. Wondering if that's overkill at this point. Thinking of asking if they can only use 1/2 dose (which would be same as Prolia) and 2 - 3 X a year. Thoughts?

BTW, having 2nd docetaxel chemo. today. Wondering if I should wait until all chemo is done before starting.....

[Magnus1964]

I have been on monthly xgeva for a few years. I think four times a year would be ok.

[Tall_Allen]

Because serious side effects increase with the time on it, consider putting it off until you are castration resistant. You might try a weaker bisphosphonate like alendronate. Also an estrogen patch might help preserve BMD (as well as hot flashes - take with tamoxifen to prevent gynecomastia). Also ask your doctor if you can do weight-bearing exercise.

Were you able to get Nubeqa instead of Zytiga?

[rsgdmd in reply to Tall_Allen]

Asked but told can have similar effects on liver. So, for now, only Lupron during chemo. Am going to ask about adding receptor blocker like Casodex while doing chemo. Am already lifting weights at least three times a week and walking, treadmill 3-5 times a week. Take stairs to my 4th floor apartment rather than elevator.

[Tall_Allen in reply to rsgdmd]

With arrhythmia, clotting is important, which can increase while doing chemo. Estrogen and tamoxifen as patches instead of pills don't have the same clotting/liver effects.

Sometimes moving to a lower dose of Zytiga won't have the same liver effects.

[Seasid in reply to rsgdmd]

Nubequa is better as you don't need Prednisone with it. Nubequa would be better for your bones. Bicalutamide is not good for your liver.

[London441 in reply to rsgdmd]

Approximately what percentage of your weight lifting is concentrated in your legs?

[rsgdmd in reply to London441]

Hard to say. I walk 2 -3 miles approx 4 times a week, mostly outdoors; if treadmill, usually at 2 -3 degrees incline. I live on 4th floor of 6 story condo & almost always use the stairs. Usually take the stairs up to the 6th floor on way up and then back dow to my floor. Occassionally do squats, but bothers my knees.Certainly spend more time with lower body, but more intense, but shorter, upper body workout.

[London441 in reply to rsgdmd]

If squats hurt your knees too much, what are you doing instead? The walking is great but is not lifting of course.

[rsgdmd in reply to London441]

Walking and, esp, walking up steps, is weight bearing exercise. I will sometimes do wall sits (2 x 30 sec) if knees are bothersome.

wall sit

[London441 in reply to rsgdmd]

We won’t argue about whether walking constitutes weight bearing exercise. I will only say that as we age, and especially on a drug like Lupron, preventing muscle loss through walking alone just isn’t possible.

The wall sits are another matter, but you need to do a whole lot of them. Your choice of course, but perhaps add leg press or similar that really loads the legs. It will also make your stair climbing outright effortless.

[rsgdmd in reply to London441]

Leg press with bands is a good idea. I'll try them. Thanks

[john4803 in reply to rsgdmd]

Man you've got a great looking body! 😂

[Seasid]

You will be fine on prolia. István

[MateoBeach]

If your teeth are in good shape I would go with the Xgeva dosing at 3 months. At least for a couple of years, and then consider spacing it out. It is not just the osteopenia, but it is the risk for skeletal events such as pathologic fractures that looms large with PC bone mets.I was on Prolia for about 4 years and I have no known bone mets. Still they are probably in my future. I recently switched to the Xgeva dosing (120 mg) every 3 months. Not sure when I would stop it. Requires care and perhaps switching to an oral bisphosphonate for a time.

[tango65]

My understanding of bone agents in PC is that in hormone sensitive cancer they are not used unless there is evidence of osteoporosis (T -2.5 or less) and/or a high FRAX score for fracture. Osteopenia is not treated in castration sensitive cancer.

There is no evidence than in castration sensitive cancer,(even metastatic) bone agents offer any advantage in the absence of osteoporosis.

It is different in M1b castration resistant cancer where these drugs help to reduce skeletal events.

[Gearhead in reply to tango65]

Sorry if this seems like a nit, but don't you mean T less than -2.5?

[tango65 in reply to Gearhead]

OK, you got me, I already corrected¡ Thanks

[Gearhead]

I recently convinced my oncologist to discontinue Xgeva after 3.5 years of quarterly injections. My main concern is osteonecrosis of the jaw (ONJ), which is typically triggered by dental work, and the probably of which increases over time with continuous injections. A bone scan a few months after my last Xgeva indicated mild osteopenia (Avg. T = -1.45, Avg. Z = -0.18). Be aware that some research indicates a rebound effect (decreased bone density) upon discontinuing denosumab.IMO, starting and/or stopping Xgeva is a judgment call based on your specific situation. In my case, my stable PSA <0.1 and imaging indication of no growth of my spine tumor led me to be more concerned about ONJ than bone problems.

[SeosamhM]

Similar to Gearhead, I convinced my MO to discontinue Xgeva after concerns about ONJ and its potential appearance after a couple of dental procedures a couple of years ago. Like you, I have the "osteopenia" tag based on an isolated low DEXA (my right hip) - all other numbers were normal. There is always risk, but I also want to delay these bone medications for as long as possible (e.g., see TA's response) and my longer term (3 years) experience with bone and joint discomfort while on Xgeva was considerable.

I was on Xgeva while on chemo (dox). Looking back, I think a had a lot of unnecessary side effects from this combo.

Good luck with the chemo, brother! - Joe M.

[john4803]

As a result of my extensive bone mets & slight osteopenia on my right hip, my MO wants me on Xgeva, monthly for at least 6 months & then maybe drop it to quarterly.

No limits on exercise of any kind. Also, on Lupron & Apalutamide (Casodex 2.0). Don't appear to be resistant yet (knock on head)!👍