Xgeva: new drug for bone mets: answers to recent questions

Xgeva® (denosumab) (pron x-GEE-va) is the latest addition to the arsenal of treatment for skeletal-related events (SRE) in breast cancer patients with bone metastases from solid tumors (osteoclasts). It was approved for use in metastatic breast cancer (and a few other cancers) by the US Food and Drug Administration (FDA) in November 2010. Since then, we are hearing more about it as it is being added to our treatment regimens.

Here are a few facts.

  • The two other SRE treatment drugs are Aredia® (pamidronate) and Zometa® (zoledronic acid).
  • Xgeva was shown to be superior to Zometa in preventing SRE for a longer period, but it was not shown to have an advantage in extending either progression-free survival (PFS) or overall survival (OS).
  • Xgeva does not affect the kidneys, which can be a problem for patients taking the other two drugs, Aredia or Zometa, for an extended time.
  • Xgeva’s adverse effects include hypocalcemia and, rare, osteonecrosis of the jaw (ONJ); ONJ is also a rare complication of the other two drugs.
  • Xgeva at $1650 is twice as expensive as the other drugs.
  • Amgen offers a payment assistance plan, First Step, that does not have a requirement for financial need. Ask your oncology team whether they have the packets available for patients; otherwise, visit the site and call to register for the program.
  • Denosumab has two names for its different applications: Xgeva for bone mets and Prolia® (a lower dose) for osteoporosis.

It may be likely that physicians will prescribe Xgeva for patients who, either, have renal function complications from or are intolerant of the bisphosphonate drugs, Aredia or Zometa.

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© 2004-2011 Donna Peach. All rights reserved.

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One response to “Xgeva: new drug for bone mets: answers to recent questions

  1. Don’t forget ibandronate, which also doesn’t have the renal issues of the other two bisphosphonates. It’s cheaper than Xgeva, although I think perhaps more expensive than the other bisphosphonates at the moment. It can be given more frequently at first, and therefore can sometimes relieve pain more quickly than the other bisphosphonates. It still has the ONJ risks of the other bone meds. Studies have been inconclusive as to whether it is better or worse than the other bisphosphonates in delaying SRE’s.

    Thank you for the info on Xgeva and the financial aid program – hopefully that will help people who otherwise would be unable to get the needed treatment.

    Of note: since taking the Xgeva, SOME of my bone mets have gone from lytic to sclerotic. I believe this is a relatively positive sign that these tumors are potentially growing more slowly and therefore also fracturing my bones more slowly – this was not the case with the Boniva, although the Boniva did help with the bone pain. So if Xgeva doesn’t give me more time, it might be giving me more ‘functional time’, which is still a step in the right direction…

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