Denosumab (Xgeva ®, Prolia ®)
Denosumab is a targeted therapy used to treat secondary bone cancer. It is also given to people with certain cancers to strengthen their bones.
Denosumab belongs to a group of cancer drugs called monoclonal antibodies. Monoclonal antibodies are also called targeted therapies because they work by ‘targeting’ specific proteins that are either produced by cells or found on the surface of cells (receptors).
Denosumab, as a drug also known as Xgeva ®, is given to people with cancer that has spread to the bones (secondary bone cancer) from a solid tumour. A solid tumour is a cancer that occurs in one of the body’s organs, such as the breast, kidney or lung, but not a blood cancer, like myeloma or leukaemia.
As a drug also known as Prolia ®, denosumab can be given to men with prostate cancer who may have weakened bones from having hormonal therapy. It may also be given to some post-menopausal women with breast cancer who may have weakened bones.
In normal bone, two types of cell work together to shape, rebuild and strengthen existing bone:
- osteoclasts, which break down old bone
- osteoblasts, which build up new bone.
Secondary bone cancer occurs when cells from the original (primary) cancer spread to form a new tumour (secondary cancer or metastasis) in the bone. Cancer in the bone causes the normal activity of these cells to change. As a result, osteoclasts begin to break down too much bone. This increases the risk of fractures (breaks) and can cause pain in the bones.
Denosumab works by targeting a protein called RANKL, which is needed for new osteoclasts to be made and to function. Denosumab binds to the protein and stops the production of osteoclasts. This helps to prevent further breakdown of bone and reduces the risk of problems caused by secondary bone cancer, such as fractures or compression of nerves in the spine. It can also help to reduce pain caused by secondary bone cancer.
Denosumab is given as an injection under the skin (subcutaneously) in the thigh, stomach or upper arm.
Xgeva is usually given once every four weeks.
Prolia is given once every six months.
Your doctor or nurse will take a blood test before you start your treatment to check the amount of calcium in your blood. You may need to take calcium and vitamin D tablets before starting denosumab and will be given them while you are being treated. This helps to prevent low calcium levels in the blood.
Possible side effects of denosumabBack to top
We explain the most common side effects of denosumab here. But we don’t include all the rare ones that are unlikely to affect you.
You may get some of the side effects we mention but you are very unlikely to get all of them. If you are having other drugs as well, you may have some side effects that we don’t list here. Always tell your doctor or nurse about the side effects you have.
Muscle spasms, twitches or cramps or a tingling sensation
in lips or tongue
It’s important to let your doctor know straight away if you have any of these symptoms. This can mean that the calcium level in your blood has dropped below normal and may need to be treated.
Your doctor will carry out regular blood tests to keep an eye on the amount of calcium in your blood.
Jaw problems (osteonecrosis)
Osteonecrosis of the jaw is when healthy bone tissue becomes damaged and dies. Gum disease, problems with dentures and some dental treatments can increase the risk of osteonecrosis. You’ll be advised to have a full dental check-up before taking denosumab.
During treatment with denosumab it is very important to look after your teeth by brushing them regularly and having regular dental check-ups. Let your dentist know that you are having denosumab.
Some of the symptoms of osteonecrosis can include pain, swelling, redness of the gums and loose teeth. Tell your cancer specialist and dentist straight away if you have any of these symptoms.
Denosumab (Prolia) can cause skin rashes. It is important to let your doctor know if this happens. Your doctor can prescribe medicine to help with this.
Denosumab (Xgeva) may cause diarrhoea. This is usually mild and your doctor can prescribe drugs to control diarrhoea. Let them know if it is severe or if it doesn’t get better. Make sure you drink at least two litres (three and a half pints) of fluids every day if you have diarrhoea.
Denosumab (Prolia) may also make some people constipated. Drinking at least two litres of fluids (three and a half pints) every day will help. Try to eat more foods that contain fibre (such as fruit, vegetables and wholemeal bread) and take some regular gentle exercise.
Denosumab (Xgeva) may make you feel short of breath. Always let your doctor know if you have any trouble with your breathing.
Denosumab may cause flu-like symptoms such as feeling hot or cold and/or shivery, having a headache and aching. Let your doctor know if these symptoms affect you. It may be helpful to take mild painkillers.
Denosumab (Prolia) can cause back pain. Let your doctor know if this develops. They can prescribe pain relief to help.
It is important to let your doctor know if you have any numbness or tingling in your lower back or legs. This may be caused by pressure on nerves in or around the spine (sciatica).
Let a doctor know straight away if you have any loss of bladder or bowel control, or you feel any loss of sensation in your legs.
Denosumab (Prolia) can cause cataracts (clouding of the eye’s lens). Let your doctor know if you notice any changes in your vision.
Less common side effects of denosumabBack to top
Some people feel very tired during treatment. It can be very frustrating and difficult to cope with, especially for people who normally have a lot of energy.
This is a rare side effect of denosumab. Signs of an allergic reaction can include itching, a rash, feeling short of breath and, less commonly, chest pain. Tell your nurse or doctor straight away if you have any of these symptoms so that if you are having a reaction, it can be treated quickly.
Pain in the hip, groin or thigh
A very rare side effect of denosumab is a fracture of the thigh bone (femur).
Let you doctor know if you have any new or unusual pain in your hip, groin or thigh whilst you are on denosumab.
Some medicines, including those that you can buy in a shop or chemist, may be harmful to take while you’re having denosumab. Tell your doctor about any medicines you are taking, including over-the-counter drugs, complementary therapies and herbal drugs.
You should not have Xgeva and Prolia together.
It's not advisable to become pregnant or father a child while having denosumab, as it may harm the developing baby. It’s important to use effective contraception while taking this drug, and for at least a few months afterwards. You can discuss this with your doctor or nurse.
There is a risk that denosumab may be present in breast milk. Let your doctor know if you are breastfeeding before starting this treatment.
If you’re admitted to hospital for a reason not related to the cancer, it’s important to tell the doctors and nurses looking after you that you are having denosumab. You should tell them the name of your cancer specialist so that they can ask for advice.
It’s a good idea to know who you should contact if you have any problems or worrying side effects when you’re at home. During office hours you can contact the clinic or ward where you had your treatment. Your specialist nurse or doctor will tell you who to contact during the evening or at weekends.
This page has been compiled using information from a number of reliable sources, including the electronic Medicines Compendium (eMC; medicines.org.uk). If you’d like further information on the sources we use, please feel free to contact us.
This information was reviewed by a healthcare professional.
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