Denosumab (Xgeva®, Prolia®)
Classification: Monoclonal Antibody
About Denosumab (Xgeva®, Prolia®)
Cancer cells from some tumors (most commonly breast, prostate and lung cancers) can spread to the bone, which is called bone metastasis. These cancer cells cause breakdown or wearing away of normal bone. In turn, affected bones become more fragile; they may be painful and can even break due to the damage from the cancer cells. Denosumab is a type of monoclonal antibody, which is a medicine designed to target a specific protein or cell – in this case, the target is a protein called RANKL, which is necessary for bone breakdown. By targeting RANKL, denosumab inhibits bone breakdown.
How to Take Denosumab
Denosumab is given every 4 weeks by subcutaneous injection (SQ, given under the skin, similar to insulin). In addition, your healthcare provider may have you take calcium and vitamin D supplements to help with your bone health and prevent your blood calcium levels from getting too low. Talk with your team about what doses are right for you. You should drink plenty of fluids while taking this medication. Try to drink 8-10 glasses of non-alcoholic, non-caffeinated liquids a day.
Possible Side Effects of Denosumab
There are a number of things you can do to manage the side effects of denosumab. Talk to your doctor or nurse about these recommendations. They can help you decide what will work best for you. These are some of the most common side effects:
Low Blood Calcium (Hypocalcemia)
Denosumab can cause your blood calcium levels to drop below normal. Calcium and vitamin D supplements can be taken to prevent the level from getting too low. Signs that calcium levels are low include: numbness or tingling sensation around the lips, muscle stiffness, twitching, spasms or cramps. Be sure to notify your oncology team if these symptoms occur.
Nausea and/or Vomiting
Talk to your doctor or nurse so they can prescribe medications to help you manage nausea and vomiting. In addition, dietary changes may help. Avoid things that may worsen the symptoms, such as heavy or greasy/fatty, spicy or acidic foods (lemons, tomatoes, oranges). Try antacids, (e.g. milk of magnesia, calcium tablets such as Tums), saltines, or ginger ale to lessen symptoms.
Call your doctor or nurse if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion that is not usually relieved by rest. While on cancer treatment, and for a period after, you may need to adjust your schedule to manage fatigue. Plan times to rest during the day and conserve energy for more important activities. Exercise can help combat fatigue; a simple daily walk with a friend can help. Talk to your healthcare team for helpful tips on dealing with this side effect.
In some cases, patients can have an allergic reaction to this medication. Signs of a reaction can include: decreased blood pressure, shortness of breath, lip swelling, rash, itching and hives. If you notice any changes in how you feel during or after the injection, let your healthcare team know immediately.
Osteonecrosis of the Jaw
Osteonecrosis of the jaw (ONJ) is a rare side effect, however, it is important that you know about it and take steps to protect your dental health. The maxilla (upper jaw bone) and mandible (lower jaw bone) are normally covered by gum tissue. In the case of ONJ, this tissue is gone and the bone is exposed. Typical symptoms associated with ONJ are: pain, swelling or infection of the gums, loosening of the teeth, exposed bone (often at the site of a previous tooth extraction). Some patients may report numbness or tingling in the jaw or a "heavy" feeling jaw. ONJ may have no symptoms for weeks or months and may only be recognized by the presence of exposed bone. ONJ most often occurs soon after a dental procedure, though not always. Stop treatment with denosumab at least 3 weeks prior to any dental procedures.
- Prior to starting therapy, you should have a complete dental exam, cleaning, and removal of any teeth in poor health.
- Dentures should be checked for proper fit.
- Brush your teeth after meals and at bedtime with a soft brush. Floss gently once a day. If your gums bleed, talk with your healthcare team to see if you can continue to floss.
- Check your teeth and gums in a mirror daily for any sores, swelling, loose teeth, pain or numbness, or other changes and report these to your dentist or oncology team immediately.
Femur (Thigh Bone) Fracture
This medication can cause atypical femoral fractures (thigh bone) with minimal or no trauma contributing to the fracture. If you experience new or unusual thigh, hip or groin pain, contact your healthcare team immediately.
Exposure of an unborn child to this medication could cause birth defects, so you should not become pregnant or father a child while on this medication. Effective birth control is necessary during treatment. Even if your menstrual cycle stops or you believe you are not producing sperm, you could still be fertile and conceive. You should consult with your healthcare team before breastfeeding while receiving this medication.