Pronounce: den-OH-sue-mab
Classification: Monoclonal Antibody
Cancer cells from some tumors (most commonly breast, prostate and lung cancers) can spread to the bone. When this happens, it is called bone metastasis. Cancer cells in the bone can cause breakdown or wearing away of normal bone. In turn, the 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. It 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 or stops bone breakdown.
Monoclonal antibodies are created in a lab to attach to the targets found on specific types of cancer cells. The antibody “calls” the immune system to attack the cell it is attached to, resulting in the immune system killing the cell. These antibodies can work in different ways, including stimulating the immune system to kill the cell, blocking cell growth, or other functions necessary for cell growth. This medication is different from Denosumab (Prolia®) which treats osteoporosis. They are used to treat different issues, are not interchangeable, and also should not be taken at the same time.
Denosumab (Xgeva®) is usually given every 4 weeks by subcutaneous injection (SQ, given under the skin, similar to insulin). 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.
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:
Fatigue is very common during cancer treatment and is an overwhelming feeling of exhaustion and weakness 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 these side effects. 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.
This medication can affect the normal levels of electrolytes (phosphorus) in your body. Your levels will be monitored using blood tests. If your levels become too low, your care team may prescribe specific electrolytes to be given by IV or taken by mouth. Do not take any supplements without first consulting with your care team.
Talk to your oncology care team 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 saltines, or ginger ale to lessen symptoms.
Call your oncology care team if you are unable to keep fluids down for more than 12 hours or if you feel lightheaded or dizzy at any time.
This medication can cause shortness of breath. If you have sudden shortness of breath or chest pain, call 911 or go to the Emergency Room right away.
There are several things you can do to prevent or relieve constipation. Include fiber in your diet (fruits and vegetables), drink 8-10 glasses of non-alcoholic fluids a day, and keep active. A stool softener once or twice a day may prevent constipation. If you do not have a bowel movement for 2-3 days, you should contact your healthcare team for suggestions to relieve the constipation.
Your red blood cells are responsible for carrying oxygen to the tissues in your body. When the red cell count is low, you may feel tired or weak. You should let your oncology care team know if you experience any shortness of breath, difficulty breathing or pain in your chest. If the count gets too low, you may receive a blood transfusion.
Your oncology care team can recommend medications to relieve diarrhea. Also, try eating low-fiber, bland foods, such as white rice and boiled or baked chicken. Avoid raw fruits, vegetables, whole-grain breads, cereals, and seeds. Soluble fiber is found in some foods and absorbs fluid, which can help relieve diarrhea. Foods high in soluble fiber include: applesauce, bananas (ripe), canned fruit, orange sections, boiled potatoes, white rice, products made with white flour, oatmeal, cream of rice, cream of wheat, and farina. Drink 8-10 glasses of non-alcoholic, un-caffeinated fluid a day to prevent dehydration.
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 and for 5 months after treatment for women. 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.
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