Understanding Xgeva and Its Role in Treating Bone-Related Issues

If you are suffering from advanced cancer that has spread to your bones, then Xgeva is an option that can help you prevent bone-related complications. The FDA first approved this drug on November 18, 2010 [1]. Several studies have shown that Xgeva is more effective in managing bone-related complications than other medications. In this article, we will explore everything you need to know about Xgeva, including its side effects, dosage, cost, and more.

What Is Xgeva?

Xgeva (denosumab) is a brand-name prescription medicine used to prevent bone-related complications in patients whose cancer has spread to the bones. These complications can include bone fractures and pressure on the spinal cord. Xgeva can also be used to treat high blood levels of calcium caused by cancers when other medications are ineffective. 

Xgeva is a monoclonal antibody. It helps you by reducing bone damage and increasing bone density. In clinical studies, researchers found that Xgeva was more effective than other drugs in preventing bone-related problems in cancer patients. In patients with multiple myeloma, a type of blood cancer, Xgeva helped prevent bone-related complications for about 23 months [2].

What Is Xgeva Used To Treat?

Xgeva is FDA-approved for use in the following cases [2]:

Prevention of Bone Fractures: Doctors use Xgeva to prevent bone fractures in adult patients with multiple myeloma and bone metastasis from solid tumors. Multiple myeloma is a type of blood cancer that affects the bone marrow. It can cause fractures in your bones, resulting in symptoms like pain in the back, ribs, hips, chest, or skull. Bone metastasis is a condition where cancer cells spread from their original location to the bones. Symptoms include neck and back pain, muscle weakness, fever, and low platelet count.

Treatment of Giant Cell Tumors of Bones: Doctors use this medication to treat adults and adolescents with giant cell tumors of the bone when the tumor cannot be completely removed through surgery or when surgery poses significant risks.

Treatment of Hypercalcemia Caused by Cancers: Hypercalcemia is a condition where there is too much calcium in the blood. It can cause complications in the bones, kidneys, stomach, brain, and heart. Xgeva is approved to treat adults with hypercalcemia caused by cancer, but only after they have tried a type of drug called bisphosphonate.

How Does Xgeva Work?

Xgeva (denosumab) is an FDA-approved medicine used to prevent bone-related problems in patients whose cancer has spread to the bones. In our bodies, there is a balance between bone-forming cells called osteoblasts and bone-destroying cells called osteoclasts. However, cancer that has spread to the bones breaks this balance. As a result, more and more bones start to break down.

The active ingredient is denosumab, which is a monoclonal antibody. It works by attaching and blocking the activity of a protein called RANKL. RANKL is necessary to create and maintain osteoclasts (cells that break down bones). Xgeva works by blocking RANKL, which decreases bone loss and prevents bone-related problems like fractures [2].

Side Effects

Like any other medication, Xgeva can have side effects. Here are some mild to severe side effects [2][3]:

Mild Side Effects

Mild side effects include: 

• Back and joint pain
• Nausea
• Difficulty breathing
• Tiredness and weakness
• Cough
• Headache
• Low levels of phosphate
• Appetite loss
• Toothache
• Swelling in your legs and arms

These mild side effects usually go away on their own within a few days to a few weeks. However, if they do not go away or become worse, consult your doctor.

Severe Side Effects

Severe side effects include the following:

Low Calcium Level in Blood: Xgeva can lower the level of calcium in your blood. A low calcium level can cause symptoms like muscle spasms, stomach pain, extreme thirst, vomiting, and nausea.

Osteonecrosis of the Jaw: Xgeva can cause your jaw bones to die as it reduces blood supply to the jaw. As a result, patients can experience symptoms like jaw pain, numbness, swelling, and loose teeth. It is recommended that you maintain good oral hygiene and get regular dental check-ups while using this medication.

Allergic Reactions: Xgeva can cause severe allergic reactions in rare cases. Symptoms include rash, difficulty breathing, and itching.

Pneumonia: This is the most common severe side effect in multiple myeloma patients receiving Xgeva. Pneumonia is an infection in the lungs with symptoms like difficulty breathing, high fever, rapid breathing, cough, and rapid heart rate.

Please note that this is not a list of all possible side effects. Contact your provider immediately if you encounter any serious side effects.

Dosing Information

The dosage of Xgeva depends on several factors, such as your age, current condition, and medical history. Your doctor will determine the right dosage based on your situation. You will receive Xgeva as a subcutaneous injection in your upper arms, upper thighs, or abdomen. The usual recommended dose for different conditions is given below [2]:

Multiple Myeloma and Bone Metastasis From Solid Tumors: The recommended dose is 120 mg every 4 weeks. If calcium levels in your blood become too low, you may also be prescribed calcium and vitamin D supplements.

Giant Cell Tumor of Bone: The recommended dose is 120 mg every 4 weeks. In your first month of Xgeva treatment, you will receive two additional 120 mg doses on Day 8 and 15. You will also receive calcium and vitamin D supplements if the calcium levels in your blood become too low.

Hypercalcemia Caused by Cancers: The recommended dose is 120 mg every 4 weeks with additional two 120 mg doses on Day 8 and Day 15 of the first month of treatment.

Xgeva Cost

Xgeva is available as a 120 mg/1.7 ml solution in a single-dose vial. Each single-dose vial costs around $3,470 [4]. However, the actual cost of treatment will depend on your insurance coverage, location, treatment plan, and the pharmacy you visit. Contact us if you are interested in receiving financial assistance.

Before You Start

Before starting your Xgeva treatment, there are some facts you need to be aware of in order to ensure that it is safe and appropriate for you:

• Before starting your treatment, inform your doctor of your medical history. Also, tell them about all the medicines you are using, including over-the-counter drugs, vitamins, and herbal medicines.
• Tell your doctor if you are pregnant or want to become pregnant. Xgeva can harm your unborn baby. You need to have a negative pregnancy test before starting Xgeva treatment.
• While receiving Xgeva, you should not take Prolia (another denosumab product like Xgeva).
• Xgeva can damage your jaw bones. So, while taking Xgeva, you should have good dental hygiene and regular dental check-ups.
• Xgeva treatment is very expensive. Before starting the treatment, you need to discuss the cost with your doctor and insurance provider. You should also inquire about any financial assistance programs that can help you with the cost.

FAQs 

Here are some frequently asked questions about Xgeva:

1. Can I take Prolia instead of Xgeva?

Xgeva and Prolia are brand-name drugs containing the same active ingredient, denosumab. However, Xgeva and Prolia are used to treat different conditions and they have different administration routes. So, if your doctor prescribed Xgevia, you can NOT  use Prolia.

2. For how long do I have to take this medication?

You have to take Xgeva once every 4 weeks for a long time. However, you should stop using it if Xgeva is ineffective for you or if you encounter severe side effects.   

3. Can I use Xgeva if I have kidney problems?

Yes. You can use Xgeva, but you need to be careful. People with kidney problems have a higher chance of developing hypocalcemia (low calcium level in blood) when using Xgeva [2]. So, your calcium levels should be monitored regularly. Your doctor will prescribe calcium and vitamin D supplements if necessary.