Denosumab (Xgeva®, Prolia®)

You will be given denosumab at the hospital as an outpatient. You have it as an injection under the skin (subcutaneously). You have the injection in the thigh, stomach or upper arm.

• XGEVA® is given once every 4 weeks.
• Prolia® is given once every 6 months.

You will have a blood test before each treatment to check the amount of calcium in your blood.

During a course of treatment you usually see a:

• cancer doctor
• chemotherapy nurse or specialist nurse
• specialist pharmacist.

This is who we mean when we mention doctor, nurse or pharmacist in this information.

Your will have regular blood tests to check your calcium levels. If they are low, your doctor, nurse or pharmacist will prescribe calcium and vitamin D supplements for you.

Contact your cancer team or hospital straight away if you get any of these signs:

• muscle spasms, twitching or cramps
• tingling around your mouth or in your fingers and toes
• drowsiness or confusion.

This treatment 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, nurse or pharmacist if this happens. They can give you painkillers to help.

A rare side effect of this treatment is a fracture of the thigh bone (femur). Tell your doctor, nurse or pharmacist if you have any new or unusual pain in your hip, groin or thigh during or after treatment.

Osteonecrosis of the jaw is when healthy bone tissue becomes damaged and dies.

The risk of getting osteonecrosis can increase due to:

• gum disease
• problems with dentures
• some dental treatments.

Your doctor, nurse or pharmacist will advise you to have a full dental check-up before starting denosumab. It is important to them if you are having or plan to have dental treatment. 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 treatment with denosumab. Brush them regularly and have regular dental check-ups. Let your dentist know you are having denosumab.

Some of the symptoms of osteonecrosis can include:

• pain and swelling in your jaw
• redness of the gums or gum infections
• loosening of teeth.

Tell your cancer team 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, nurse or pharmacist straight away.

Prolia® can cause skin rashes. It is important to tell your doctor, nurse or pharmacist if this happens. They 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, nurse or pharmacist straight away.

This treatment may cause diarrhoea. Diarrhoea means passing more stools (poo) than is normal for you, or having watery or loose stools. You may also have stomach cramps. If you have a stoma, it may be more active than usual. 

If you are passing loose stools 3 or more times a day and this is not normal for you, contact the hospital as soon as possible on the 24-hour number. Follow the advice they give you about:

• taking anti-diarrhoea medicines 
• drinking enough fluids to keep you hydrated and to replace lost salts and minerals
• any changes to your diet that might help. 

They might also ask you for a specimen of your stool to check for infection.

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 on the 24-hour number for advice. They can give you drugs called laxatives to help. 

If you have not been able to pass stools for over 2 days and are being sick, contact the 24-hour number straight away. 

This treatment may cause flu-like symptoms such as:

• feeling hot or cold or shivery
• a headache 
• muscle or body aches. 

Tell your doctor, nurse or pharmacist if these symptoms affect you. It may help to take mild painkillers.

Prolia® can cause back pain and sciatica. Tell your doctor, nurse or pharmacist if this happens. They can give you painkillers to help.

Contact your cancer team or the hospital straight away if you have:

• numbness or tingling in your lower back or legs - this may be caused by pressure on nerves in or around the spine
• weakness or loss of sensation in your legs
• loss of bladder or bowel control.

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, nurse or pharmacist if you have any concerns.

You may have more urinary tract infections or chest infections with Prolia®. Tell your doctor, nurse or pharmacist if you have any symptoms linked with infection.

Some medicines can affect how this treatment works or be harmful while you are having it. Always tell your cancer doctor, nurse or pharmacist about any drugs you are taking or planning to take, such as: 

• medicines you have been prescribed
• medicines you buy in a shop, pharmacy or online
• vitamins or supplements 
• herbal drugs and complementary or homeopathic therapies
• recreational drugs – for example, cannabis.

Cancer doctors usually recommend that people with cancer have vaccinations for flu and coronavirus (covid). They may also recommend other vaccines, such as Shingrix^® for shingles. These all help reduce your risk of serious illness from these infections. Most people can have these vaccines, including people with weak immune systems.

You should not have live vaccines if your immune system is weak. This includes if you are having or recently had chemotherapy, radiotherapy or other cancer treatments that affect your immune system. Live vaccines can make you unwell because they contain a very weak version of the illness they protect you against. There are several live vaccines. These include the yellow fever vaccine and Zostavax^®, which is a different type of shingles vaccine.

It is important to ask your doctor, nurse or pharmacist for advice about having vaccinations. They can explain what vaccines are right for you and when it is best to have them.

Some cancer drugs can affect whether you can get pregnant or make someone pregnant. If you are worried about this, it is important to talk with your doctor before you start treatment.

Your doctor, nurse or pharmacist will advise you not to get pregnant or make someone pregnant while having this treatment and for some time afterwards. The drugs may harm a developing baby. It is important to use contraception to prevent pregnancy. Follow their advice about:

• what types of contraception to use 
• how long after treatment you should continue to use contraception. 

You are advised not to breastfeed while having this treatment, or for some time after treatment ends. This is because the drugs could be passed to the baby through breast milk. 

Your doctor, nurse or pharmacist can give you more information.

If you need medical treatment for any reason other than cancer, always tell the healthcare professional that you are having cancer treatment. Give them the contact details for your cancer doctor or cancer team so they can ask for advice.

If you have appointments with a dentist, always tell them you are having cancer treatment. Talk to your cancer team before you have any dental treatment.