Zometa

[MyDogs2]

Hi all, been on Zometa every three month, but having concerns to how it is affecting my kidneys, since my kidneys function has been declining consistently and creatinine numbers rising as well, anyone else having same issues? Thank you in advance for sharing your experience with this drug.

[awesome4ever]

Hi Mydogs2...cute name by the way. I have been receiving Zometa(zoledronic acid) by infusion every 3 months since May 2018. I have not had any issues with my kidney function and my labs are all normal. As you probably know Zometa is not metabolized but is excreted unchanged via the kidney. Over the first 24 hours, 39 to 46% of the administered dose is recovered in the urine, while the remainder is principally bound to bone tissue. You said your creatinine is rising but more importantly what is your eGFR level? That is a much better indicator of how your kidneys are doing and should be checked prior to your quarterly Zometa infusions...at least within a month of.

Several tips with the infusion...make sure you are well hydrated prior to the infusion and drink tons of water the day following to help clear your kidneys and avoid nephrotoxicity. Ask to have your drug infused over a longer period of time...I have always done 30 minutes and have a small flush before the medication and a 10 minute flush after.

I know people will probably respond to you to ask to get switched to Xgeva ( Denosumab) which is easier on the kidneys but I imagine you being from Canada like I am...Xgeva may not be covered as it is not for me. Take care.

[MyDogs2 in reply to awesome4ever]

Hi awesome4ever thank you so much for your kind and so informative response, actually my GFR level dropped to 36 which it means I’m at stage 3b, but as I mentioned my concern to my oncologist she doesn’t seem to share my concerns. And yes you’re right in Canada Xgeva only covers treatment for bone Mets from prostate cancer not for breast cancer, so definitely we’re out of luck unless you pay for it. I will follow your advice and tips concerning the infusion itself as well before and after, I wish I was given that information by medical team. Thanks again and good luck to you . 💗

[awesome4ever in reply to MyDogs2]

You are most welcome! Happy to help anytime if you have questions. Yes a GFR of 36 is on the lower side(ideally should be greater than 59) but still with a few adaptations you should be able to continue with the Zometa long into the future. I just checked my portal and my eGFR has remained in the 90 range for all my treatments. Another thing that affects the kidneys and your GFR level is the IV contrasts given for the CT scan if that's what they use for surveillance. Again always make sure you are well hydrated before and after those scans. I drink alot of water each and every day. Take care and thanks for the well wishes.

[Red1246 in reply to awesome4ever]

Your response is so very knowledgeable and helpful - thank you. I have Chronic Kidney Disorder and my nephrologist recently asked my oncologist if I might have scans without the dye. She agreed saying if anything untoward appeared, she would Re-do them with dye. I also have a flush before and after Zometa treatments and the infusion itself over a 1/2 hr VS 15 mins.

Nephrologist has never mentioned my changing from Zometa. And again, drinking a lot of water is key and I never seen to be able to get enough. Thanks again for sharing,

[NPmary in reply to MyDogs2]

I just want to validate your concern, I would be as well. If I had this experience I would definitely ask the doc why he is not concerned and if in his experience the kidney problems resolve if you discontinue zometa. For me, I don't know that I would risk kidney disease that is occurring for a bone fracture which may never occur. Wish you the best and hope I am not too depressing.🌺❤️🌺

[TwithBC in reply to NPmary]

Indeed--

[MyDogs2 in reply to NPmary]

Hi NPmary thank you for your opinion, I absolutely agree with you and on my next appointment will bring it up to my oncologist, sometimes we need to get involved in the treatment process and analyze the benefits vs the negatives. Best wishes for you as well 💗

[kiwi67]

I have the same problem. I have only one kidney ( had left 1 removed in March 2019 for cancer), then dam me a year later had breast cancer. I have done some research because after my first Zometa infusion my eGFR dropped to 40 from 46. I hadn't been told my kidney function had dropped this year so I was a bit miffed, actually a lot miffed, but its taught me to be more proactive and request all results from all tests I have. Anyway the reading I have done has told me to request a lower dose over 30 minutes in December but that's only if my eGFR has returned to within 10% of the pre Zometa infusion. On this site Red1246 had info regarding kidney function, hopefully she will see your post and reply to you, she certainly made me feel a bit more comfortable with my situation. I am now a dedicated water drinker, don't particularly like it but consider it part of my treatment.

[MyDogs2 in reply to kiwi67]

Hi Kiwi67 thank you for your response and sorry to hear about your situation as well, my kidney function has dropped drastically to 36, I’ve been concerned and talked to my oncologist about that but she told me I’m still not at a point that need to. do something about it. I’m going to request prolonging the infusion time from the actual 15m to 30m and hydrate well before and after the infusion, I just found out it’s very important to do that, hopefully it will help.

[kiwi67 in reply to MyDogs2]

Yes that's what I have read, about 30 minute infusion and also reduced dose if numbers aren't back to 10% of previous. I will also be drinking "like a lizard licking" as we say here in New Zealand.

[Red1246 in reply to kiwi67]

So glad you’re drinking more water. It IS hard and a constant struggle for me. I’ve made a new drink that is refreshing and healthy and helps mitigate the boredom of just water. I peel a piece of ginger root and turmeric root and add to a large pot of water together with a cinnamon stick and slice of lemon. I let it simmer for an hour or so and drink it hot with a spoon of honey or cold. It’s full of antioxidants and helps hydrate too. You might give it a try. Sending warmest regards. Keep well. 🥰

[TwithBC in reply to Red1246]

Mmmmm! Sounds so yummm! Thanks for the recipe.

[TammyCross in reply to TwithBC]

When I had kidney stones, the urologist told me to drink lots of water. I told him I don't like water and drink lemonade diluted with Pelligrino. He said, "Even better."

Now I am on exemestane, and it says no lemon or lime because they undermine the AI's. So I was chugging lemonade the whole time I was on anastrazole and probably shouldn't have. This website said that red grapes are helpful, so I have switched to red grape juice.

[Praising in reply to TammyCross]

No lemon water? Where did you see that? I’m on exemestane also

[TammyCross in reply to Praising]

It was a long list of what to eat and what to avoid when on exemastane. I came across it twice. It said no lemons or limes, nothing about lemon water. I just checked. It is from a website called "Foods for breast cancer." Not the kind of thing I usually read without triple checking. It applies to all aromatase inhibitors, so that means the gallons of lemonade I drank while on anastrozole didn't help. It has a long list of foods that inhibit estrogen, and then others that increase it. Here is the list of those that increase it.

Foods to avoid while taking aromatase inhibitors

Alcohol.

Beef.

Chamomile tea.

Corn oil.

Grapefruit & grapefruit juice.

Grilled, BBQ'd, or smoked meat or fish.

Lamb.

Lemons & limes.

But then on a website called Bellway, it says the opposite:

"But citrus fruits may be able to take things a step further. Fruits like oranges, lemons, and grapefruits contain phytochemicals that can act as antiestrogens and target estrogen receptors, preventing the growth of cancer cells."

So which to trust? I think I had better ask my oncology nutritionist. Maybe I can go back to my lemonade habit, but balance it with red grapes. It may have to do with an area of confusion in nutrition and breast cancer: phytoestrogens are considered by some to block estrogen receptors and help but are considered by others to act like estrogen and increase ER+ proliferation.

[Nocillo]

Water is vital. I’ve been on Zometa since 2015 and never had a problem until now that I’ve switched to twice a day Verzenio. So, tons more water for me. It’s annoying, but I don’t want kidney issues either.

[Godbeforme]

Hubby was going into kidney failure last year, it was the Lisinopril! He stopped taking it and within a few months his kidneys were back to normal. I tell everyone JUST IN CASE they are taking it. He had taken it for over 10 years before that; point being, some of these bp meds etc. can turn on you after a while. God bless you and heal us all in Jesus name, amen!

[Blondslovelife]

Hi, after 4 years of zometa I had that happen to me. Had a bone density test done 2 months before this problem was mentioned by my Dr. He stopped zometa and 2 months later gave me Xgeva. Need to mention that my bones are now back to normal after being on zometa!

[Cowgirl1951]

I had Zometa for approximately 7 years and had no issues. I had IV fluids right after the Zometa. . . . not before but after the Zometa. The nurses always wanted to slap the fluids on and I would be almost finished before they started Zometa. I clarified with my oncologist and I always reminded the nurses when they were starting the IV.

[Hopeful4Cure]

Hi all, does anyone really know how long zometa is still effective after the last dose? I ask because I have been off it since Feb of this year, because I was going to have dental work done. My last blood tests showed high calcium and so doc wants to start again. Blessings

[Praising in reply to Hopeful4Cure]

Does that lower calcium. ? Mine has been higher on xgevia.

[Hopeful4Cure in reply to Praising]

Not sure because there are other issues with zometa. If I were to have dental work, I could have problems with bone that won't heal an issue with your jaw too. I remember not to long ago someone on this site stated that she had zometa for years went off it and that the zometa continued to work?! I vaguely remember being involved in that chat. Once I am healthier, I would like to have this work done, but you can't start it until 6 months after last infusion.

[awesome4ever in reply to Hopeful4Cure]

Please be careful with elevated serum calcium. When you have high calcium caused by cancer and in particular bone mets....bone mets cause an imbalance between bone formation and bone resorption, resulting in the release of excess calcium into the blood. This can become a serious life threatening issue if it is not corrected.

I read many comments on this site about how long Zometa stays in the body for long periods...and that is a fact. Definitely 12-24 months and some say up to a decade. However the confusion lies around where this drug is stored and the amount. Bisphosphonates are not metabolized, but are either excreted renally or deposited within the bones. Only a small amount is deposited after each infusion. The amount of drug within the bone will accumulate with long term use.

Intravenously administered zoledronic acid is eliminated by a triphasic process: rapid biphasic disappearance from the systemic circulation, with half-lives of 0.23 and 1. 75 hours, followed by a long elimination phase with a terminal elimination half-life of 167 hours. From the pharmaceutical world breakdown it takes about 5 half-lives for a drug to be roughly 97% eliminated.....so approximately 35 days or so with the rest deposited into the bones.

If you read any literature from an advanced cancer perspective including MBC the oncologist should take a risk versus benefit approach but most generally it is recommended unless patient perhaps has only one or two bone mets that women with MBC should remain on this treatment indefinitely. Because SREs can occur repeatedly during metastatic disease that involves the bone, American Society of Clinical Oncology clinical guidelines recommend zoledronic acid be taken indefinitely as intravenous infusion until there is deterioration of the general health of the patients. I believe the real confusion comes from the fact that this drug of course is used extensively for patients with osteopenia and also now in patients with early breast cancer and all this data gets correlated together to help generate confusion with who should and who shouldn't.

Anyway in your case(and I'm sorry I got off topic) but I looked back through your posts and it is possible that some of the unexplained increase in bone pain you have been experiencing could be related to the hypercalcemia. Please have a good discussion with your oncologist and remember that Serum calcium levels start to gradually decrease after 2 days of treatment and fully normalize in 7 to 10 days....so it is not quickly.

Every one is different and always keep a clear mind when you read information that is strictly anecdotal. Follow proven literature and always have strong clarity in discussions with your oncologist. They aren't going to listen to you if you say you read it on a board etc...it's your life that is in their hands and their job at this point is to provide you with the best quality of life that they can. Please keep us posted. Take care.

[Hopeful4Cure in reply to awesome4ever]

You really are are awesome Thank you so much for taking the time to enrich me and others with your knowledge. I have not posted an update just yet because I still have not got back my tm's, nor the second page of my blood work. Odd as it is, last appt on the 17th, my doc only printed out the first page. However, he stated that we must start again with zometa as your calcium levels are high. So, I looked back in the last two from Sept and Aug and calcium was 10.8 and calcium w/protein 11.1. Plus, since enhertu stopped working and tm's last checked were 2130-15.3/ general 56. I've been asking for the testing of my dx for months because I blew through 3 prior drugs and my markers just keep rising. Furthermore, those bumps on my ribs, were I stated I had to move gingerly, are tumors - some are 23mmx20. Surely large enough to do a biopsy and they have been there since July. Had xray in August and sub doc stated she did not see anything. Well, at my current status, um, how about an ultra sound on those "bumps" that you can actually feel and see? Hence, I started eribulin 1st cycle, 4th treatment in a year markers rising and now I have real pain. Doc states, you have luminal A- her2low and eribulin, treats luminal B, TN and Her2+. I left the room and the tears started to swell because I want to know exactly if my dx has changed. I have lost 10 pounds in the last 2 months and it is not because I don't have an appetite, I just can't keep the weight on and he still does not address it. With regard to quality of life, my initial dx is/was suppose to be the easiest to treat. In an addition, he said enhertu is the wonder drug for you. I wonder why it did not work. I have got to stop otherwise I will continue to vent. Thank you so much again for your very detailed reply. Is greatly appreciated. Sorry, I am trying to stay positive and hopeful, just like everyone else here. Again, thank you. Blessings

[awesome4ever in reply to Hopeful4Cure]

Thanks for the clarifications. Those Calcium levels you mention must be using the mg/dl ranges as opposed to the traditionally reported values which are mmol/L? Using the mg/dl value system in Canada and I think Europe as well (you can advise me if I am incorrect) a critical value is 13.0 mg/dL. So you are definitely getting up there even with your Aug and September bloodwork. Critical levels aside, clearly your cancer is leaching calcium from your bones and dumping it into the bloodstream and in the process dissolving your bones.

Have you had a bone scan? I have large bumps on bilateral ribs that are bone mets and can be clearly seen on my bone scan as well as my CT scan actually. It is not common practice here to biopsy individual bone sites for biomarker testing. I think we can all feel the stress you are putting yourself through questioning the what-if's of most aspects of your care from what it seems. A 10 pound weight loss in 2 months is not great but not extreme unless you previously to that were already under weight. During the course of a few months with my surgeries, progression and subsequent changing treatments I lost 30 pounds and that concerned my oncologist but I knew it was side effect wise and that it would turn around eventually.

As you probably have gathered I am not a person who stresses easily and I have a medical background so very knowledgeable about things and at the same time am realistic of what to expect when I am living with a terminal disease. I also have a fabulous oncologist whom I trust and I know she is making it her job to help me maintain the best quality of life I can. Perhaps it is time for you to get a new oncologist...not a second opinion but a total change as it is apparent that you don't feel your oncologist takes you seriously. I'm truly sorry. I hope things improve.

[Hopeful4Cure in reply to awesome4ever]

That is my tone. It is enough to be proactive ourselves, but when the onc is not, yeah, there is stress. Thanks you for your reply.

[PJBinMI]

I'm a long timer with MBC,diagnosed 19 + years ago, with bone mets from the get go. That was back in 2004, before Xgeva and alot of the newer targeted drugs.

I started on Zometa soon after diagnosis. and afterthe 2nd or third time of getting it, I had an allergic reaction that stared inthe infusion room, so they pumped me ful hydrocodone and Benadrl of hydrocodone and Benadryl . Then I was switched to half the usual dose, after being given hydrocodone and Benadryl . Infusion time was switched out from 20 min. to 2 hours That workedwell! A couple of years ago, ONJ was found and treated successfully. Two things that helped getting regular dental check-ups every year and calling about it ASAP! I did have to stop the Zometa.

Ihope this helps with decision making! May you feel better about all this! .

[Hopeful4Cure in reply to PJBinMI]

Thank you for your reply. Yep, that is my issue of worry is the ONJ. My issue with dental is that many years ago, I had an accident and had to have my 2 front teeth fixed. At that time, the dentist put in posts and because of the chemo, etc, I have gum recession, plus an xray shows a small crack in the bone, in one of them. Dentist says she can't just cement the crack, but has to take it all out and do implants. Although I think there might be an easier way and less expensive, I can't really do anything now. I am embarrassed to smile showing my teeth, so the upper lip stays frozen. Thanks a mil for letting me know your experience, it does indeed help. Blessings