Denosumab (Xgeva®, Prolia®)
Denosumab is a targeted therapy drug. It is used to treat secondary bone cancer. It is also given to people with certain cancers to strengthen their bones.
- strengthen the bones
- lower the risk of a getting a broken bone (called a fracture)
- reduce bone pain.
It is best to read this information with our general information about the type of cancer you have.
Denosumab belongs to a group of targeted therapy drugs known as monoclonal antibodies. There are two types of denosumab and the one you have will depend on your situation. Each has its own brand name:
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. It is not a blood cancer, like myeloma or leukaemia.
Prolia® is given to men with prostate cancer who have weakened bones from the effects of hormonal therapy. It may also be given to women with breast cancer who have been through menopause and who have weakened bones.
Your doctor will talk to you about this treatment and its possible side effects before you agree (consent) to have treatment.
You have denosumab as an injection under the skin (subcutaneously). You have the injection in either the thigh, stomach or upper arm.
- Xgeva is usually given once every 4 weeks.
- Prolia is given once every 6 months.
Your doctor or nurse will take a blood test before each treatment. This is to check the amount of calcium in your blood.
We explain the most common side effects of this treatment here. We also include some less common side effects.
You may get some of the side effects we mention, but you are unlikely to get all of them. If you are also having treatment with other cancer drugs, you may have some side effects that we have not listed here. Always tell your doctor, nurse or pharmacist about any side effects you have.
Your doctor can give you drugs to help control some side effects. It is important to take them exactly as your nurse or pharmacist explains. This means they will be more likely to work for you. Your nurse will give you advice about managing your side effects. After your treatment is over, most side effects start to improve.
Serious and life-threatening side effects
Some cancer treatments can cause severe side effects. Rarely, these may be life-threatening. Your cancer doctor or nurse can explain the risk of these side effects to you.
Contact the hospital
Your nurse will give you telephone numbers for the hospital. If you feel unwell or need advice, you can call them at any time of the day or night. Save these numbers in your phone or keep them somewhere safe.
We cannot list every side effect for this treatment. There are some rare side effects that are not listed. You can visit the electronic Medicines Compendium (eMC) for more detailed information.
Low calcium in the blood
If you have muscle spasms, twitching or cramps, tell your doctor straight away. This also includes any tingling feeling around your mouth (lips or tongue), or in your fingers and toes.
These signs can mean that the calcium level in your blood is lower than normal. Your doctor will take regular blood tests to check your calcium levels. If it is low, your doctor will prescribe calcium and vitamin D supplements for you.
Occasionally, if calcium levels become very low, symptoms include feeling drowsy or confused. Let your doctor know if you, or other people, notice this.
Bone and muscle pain
Denosumab can cause pain in the bones and joints. This may be more common in your hands and feet. It can also cause some pain in the muscles. Tell your doctor if you have any pain in these places. Your doctor can give you painkillers to help.
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.
It is important to tell your doctor or nurse if you are having any dental treatment.
Your doctor, nurse or pharmacist will advise you to have a full dental check-up before starting denosumab. If you have any mouth ulcers or sores, you should not start treatment until they have healed.
It is very important to look after your teeth during and after having denosumab. Brush them regularly and have regular dental check-ups. Let your dentist know that you are having denosumab.
Some of the symptoms of osteonecrosis can include:
- redness of the gums
- loose teeth.
Tell your cancer specialist and dentist straight away if you have any of these symptoms.
Rarely, osteonecrosis can also affect the bones around the ears. If you have any ear pain, infection, or fluid leaking (discharge) from your ear, tell your doctor straight away.
Denosumab (Prolia) can cause skin rashes. It is important to tell your doctor if this happens. Your doctor can give you medicine to help with this.
Occasionally this treatment can cause a skin infection. If you notice an area of skin becomes red, swollen and warm to touch, tell your doctor straight away.
This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is usual for you, or having watery or loose stools. If you have a stoma, it will be more active than usual.
If you have diarrhoea:
- try to drink at least 2 litres (3½ pints) of fluids each day
- avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods
- contact the hospital for advice.
This treatment can cause constipation. Constipation means that you are not able to pass stools (poo) as often as you normally do. It can become difficult or painful. Here are some tips that may help:
- Drink at least 2 litres (3½ pints) of fluids each day.
- Eat high-fibre foods, such as fruit, vegetables and wholemeal bread.
- Do regular gentle exercise, like going for short walks.
If you have constipation, contact the hospital for advice. Your doctor can give you drugs called laxatives to help.
This treatment may cause flu-like symptoms such as:
- feeling hot or cold or shivery
- a headache
- muscle or body aches.
Tell your doctor if these symptoms affect you. It may help to take mild painkillers.
Denosumab (Prolia) can cause back pain. Tell your doctor if this happens. They can give you painkillers 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.
Tell your doctor straight away if you have any weakness, loss of bladder or bowel control, or you feel any loss of sensation in your legs.
Denosumab (Prolia) can cause clouding of the eye’s lens (cataracts). Tell your doctor if you notice any changes in your vision. Do not drive if your vision has been affected.
Sweating more than usual
Some people may find that they sweat more than usual while having this treatment. Try to drink plenty of fluids if this happens. You can talk to your doctor if you have any concerns.
This is a rare side effect of denosumab. Signs of an allergic reaction can include:
- a rash
- feeling short of breath
- 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). Tell your doctor if you have any new or unusual pain in your hip, groin or thigh while you are having treatment with 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.
Denosumab contains a type of sugar called fructose. If you are allergic to fructose, tell your doctor before starting this treatment.
Denosumab (Prolia) may contain latex in the needle cover used for the injection. Tell your doctor if you are allergic to latex.
Your doctor will advise you not to get pregnant or father a child while having this treatment and for at least 5 months afterwards. The drugs may harm the developing baby. It is important to use effective contraception during your treatment.
You are advised not to breastfeed while having this treatment, or for some time after treatment finishes. This is because the drugs could be passed to the baby through breast milk.
Your doctor or nurse can give you more information.
Medical and dental treatment
If you need medical treatment for any reason other than cancer, always tell the doctors and nurses you are having cancer treatment. Give them the contact details for your cancer doctor so they can ask for advice.
If you think you need dental treatment, talk to your cancer doctor or nurse. Always tell your dentist you are having cancer treatment.