Denosumab (Xgeva®, Prolia®)

Denosumab is a targeted therapy drug used to treat cancer that has spread to the bone (secondary bone cancer). It is also given to people with certain cancers to help strengthen bones.

Denosumab is given as an injection. You usually have it as an outpatient. Your cancer doctor or nurse will tell you how often you will have it.

Like all targeted therapy drugs, denosumab can cause side effects. Some side effects can be serious, so it is important to read the detailed information below.

How targeted therapy affects people varies from person to person. It’s important to read about the side effects so that you know what to expect. Your healthcare team can talk to you more about this and give you advice on how to manage any side effects.

Tell your doctor or nurse straight away if you:

  • have a temperature
  • feel unwell
  • have severe side effects, including any we don’t mention here.

If you need to seek medical attention for any reason other than cancer, always tell the healthcare staff that you are having this treatment.

What is denosumab?

Denosumab is a type of drug called a monoclonal antibody. These drugs are sometimes called targeted therapies. They work by ‘targeting’ specific proteins (receptors) on the surface of cells.

There are two different types of denosumab. Each has its own brand name. Which one you have will depend on your situation.

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.

Prolia® 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.

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos

How targeted therapies work

This animation shows how targeted therapies work and what effect they have on the body.

About our cancer information videos


How denosumab works

Denosumab can help strengthen bones, reduce bone pain, and lower the risk of problems such as breaks (fractures).

In normal bone, two types of cell work together to shape, rebuild and strengthen existing bone. These are:

  • osteoclasts, which break down old bone
  • osteoblasts, which build up new bone.

When cancer has spread to the bone (secondary bone cancer) it can cause the normal activity of these cells to change. If the osteoclasts break down too much bone, this can cause pain in the bones. It can also increase the risk of breaks (fractures).

Denosumab works by targeting a protein called RANKL, which is needed for new osteoclasts to be made and to function. This helps to prevent further breakdown of bone and reduces the risk of problems caused by secondary bone cancer, such as fractures. It can also help to reduce pain caused by secondary bone cancer.


How denosumab is given

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 each treatment to check the amount of calcium in your blood. You may need to take calcium and vitamin D tablets before and during treatment with denosumab. This helps to prevent low calcium levels in the blood. Calcium helps to strengthen the bones, and vitamin D helps your body to absorb the calcium.


Possible side effects

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 haven’t listed here. Always tell your doctor, nurse or pharmacist about any side effects that 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.

More information

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.

Muscle spasms, twitches, cramps or a tingling

Denosumab can help strengthen bones, reduce bone pain, and lower the risk of problems such as breaks (fractures).

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 can mean that the calcium level in your blood has dropped below normal and may need to be treated. Your doctor will take regular blood tests to check your calcium levels.

Occasionally, if calcium levels become very low, symptoms include becoming drowsy or confused. If you or someone else notice this, contact your doctor straight away.

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 prescribe 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.

Before starting denosumab you will advised to have a full dental check-up. If you have any mouth ulcers or sores, you should not start treatment until they have healed.

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
  • loose teeth.

Tell your cancer specialist and dentist straight away if you have any of these symptoms.

Skin rashes

Denosumab (Prolia) can cause skin rashes. It is important to tell your doctor if this happens. Your doctor can prescribe medicine to help with this.

Occasionally this treatment can cause a skin infection. If you notice an area of skin that turns red or becomes warm to the touch, tell your doctor straight away.

Diarrhoea

If you have diarrhoea, contact the hospital for advice. Try to drink at least 2 litres (3½ pints) of fluids every day. It can help to avoid alcohol, caffeine, milk products, high-fat foods and high-fibre foods.

Constipation

This treatment can cause constipation. 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.

Breathlessness

Denosumab (Xgeva) may make you feel short of breath. Always tell your doctor if you have any trouble with your breathing.

Flu-like symptoms

Denosumab may cause flu-like symptoms such as:

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

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

Back pain

Denosumab (Prolia) can cause back pain. Tell your doctor 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.

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.

Eye changes

Denosumab (Prolia) can cause cataracts (clouding of the eye’s lens). 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.


Less common and rare side effects

Allergic reaction

This is a rare side effect of denosumab. Signs of an allergic reaction can include:

  • itching
  • 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 whilst you are taking denosumab.


Other information

Other medicines

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.

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.

Fertility

Doctors don’t yet know how this treatment may affect your fertility (the ability to become pregnant or father a child). If you are worried about this, talk to you doctor before treatment starts.

Contraception

Your doctor will advise you not to get pregnant or father a child while having this treatment and for some time afterwards. The drugs may harm the developing baby. It is important to use effective contraception.

Breastfeeding

Women are advised not to breastfeed while having this treatment and for some time afterwards. This is because the drugs could be passed to the baby through breast milk.

Medical and dental treatment

If you need medical treatment for any reason other than cancer, always tell the doctors and nurses that 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 this treatment.