Is there any benefit to dosing Xgeva at 90 day intervals, vs the usual 4 week intervals. Everything I read seems to indicate " useless if not given every 4 weeks". It's been nearly a year (April) since dosing went from 28 days to 90 days, and at about the 6 month mark of that change, is when x-rays revealed a t-11 vertebral fracture. My oncologist wrote it off as "Osteoporotic" Wasn't 2-1/2 years of Xgeva supposed to strengthen the bones???? Dexa scans after the x-ray revealed the fracture, show osteopenia .
11/7/2022 10:56 AM
Narrative
COMMENT: A baseline DEXA scan was performed.
This report includes standards established by the ISCD (International Society for Clinical Densitometry) and Osteoporosis criteria from the World Health Organization.
LUMBAR SPINE:
The average bone mineral density is 0.931 g/sq cm. This corresponds to a T-score of -1.5.
LEFT HIP:
The average bone mineral density of the entire hip, excluding Ward's triangle is 0.803g/sq cm. This corresponds to a T-score of -1.5.
The average bone mineral density of the femoral neck is 0.621g/sq cm. This corresponds to a T-score of -2.3.
There were some clinical trials that looked at monthly vs 90-day injections and found no difference. However, many argued that the trials did not run long enough to see the cumulative damage caused by the longer interval. There is a longer-running clinical trial currently running.
Fred Saad (an expert in this) advocates monthly injections for 2 years at a time:
"And you and I have heard many people say, "Well, maybe we don't need to treat them that intensely. We can maybe spread out the number of doses." And we actually did it in several analyses, and when you dose de-intensify, the risk of these events increases significantly and so, I think in that state, every four weeks remains important. The question is how long? And, obviously, people are worried with long exposures of osteonecrosis of the jaw, among other issues, and so personally, after two years, we take a step backwards... And we did an analysis looking at different centers in Canada, some that give every three months and some that give every four weeks, and we saw that patients that were getting it every three months that needed it, were actually having almost the same event rate as patients not treated at all."
(A) there is no additional risk for every 4 weeks, and
(B) there is some possible evidence for additional risk for every 90 days.
There just doesn't seem to be much reason to "risk a lot for a little". In this case risking a lot for nothing... other than perhaps scheduling convenience?
I'm struggling with this one too. Treatment for metastatic (bones and maybe lungs) and currently hormone sensitive began January 2022, included monthly Xgeva. I questioned my MO on dosing interval last month. His plan was monthly for 2 years, then maybe back down to 90 days or maybe even 180. We agreed to do 60 days starting now based on my concerns about long term effects. Not sure if that's the right answer.
The Saad experience (sad to say) was not randomized. Those who elected or Dr put them on 90 day Xgeva May have had higher risk than those who elected no treatment. (selection bias) We know the half dose treatment at 6 months (Prolia) does some good. Seems reasonable to do monthly Xgeva for a few years then lower treatment frequency. As long as the teeth are in good shape and until we know more. Obviously protection is partial and not perfect. Must also optimize other factors of exercise ( and not just walking) and nutritional (calcium and D3 monitored). Some probably wait too long to start bone protection when they have APC and are on ADT. We know what is likely coming and I would prefer to be out front on it. Just my opinion.
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