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Xgeva and Necrosis of Jaw

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Posted 1/28/2017 8:38 AM (GMT 0)
Gary has had to have some teeth extracted in upper jaw, and despite the dentists best effort, the bone at the extraction site is not healing. He has an appointment with a dental surgeon and I requested that he skip his monthly xgeva injection in January. The more I read about this, I think he should discontinue xgeva altogether. His jaw pain is the worst pain he has right now, and his last bone scans showed much improvement.
Any thoughts from those who are on xgeva, or have had an issue with this side effect? Would a bone density scan help us decide if he's good to quit the drug?
Thanks in advance for any insight.
Beth for Gary
Posted 1/28/2017 12:27 PM (GMT 0)
Sorry to hear about that complication. How frustrating.

Jaw necrosis is a clear risk with denosumab (Xgeva, Prolia).

My oncologist requested a "clearance letter" from my dentist before beginning Prolia shots due to this risk. Prolia is the same as Xgeva, just a much lower dose (Prolia is 60 mg once every 6 months, Xgeva is 120 mg every 4 weeks). So even at that lower dose rate they were concerned.

I have no idea how fast Xgeva would clear from one's system, so whether or not skipping a shot would have much effect.

Here's hoping a dental surgeon can give you some direction.
Posted 1/28/2017 4:18 PM (GMT 0)
Tough decision; unfortunately
I am surprised the dentist did the extractions because this is not recommended for people on Xgeva:
(from the Amgen website) Avoid invasive dental procedures during treatment with Xgeva.

Also from the Xgeva (Amgen) site, The mean elimination half-life was 28 days.
Posted 1/28/2017 4:54 PM (GMT 0)
Just me, and I would ask your doctor(s), but I would stop Xgeva until these are healed.

I did have exposed bone after something caused trauma to my one tooth (eating nuts or something). I only get Xgeva every 6 months, but I did stop it for a period of time and this exposed bone healed over...I've been taking Xgeva every 6 months since.
Posted 1/28/2017 5:39 PM (GMT 0)
Thanks for the info guys. Sr, Gary's dentist tried root canals unsuccessfully a couple of times. He notified the MO prior to extraction. Fortunately it was on the top, which I understand is less risk than the bottom. His dentist said he doesn't see necrosis, but since it's not healing at extraction site for over a month now, it has to be related. That and his low platelets. Thanks again. You have confirmed my gut feeling that we should stop xgeva as precautionary measure if nothing else, at least until he sees a specialist.
Beth
Posted 2/9/2017 6:45 AM (GMT 0)
Gary saw the oral surgeon today and necrosis from xgeva was confirmed. Unfortunately the surgeon felt that any treatment would only cause undue trauma to Gary, and that he had been on xgeva for so long, at this point, discontinuation would do little to reverse the necrosis. He also confirmed necrosis setting in around his front teeth implants. At this point he is suggesting that Gary remove the bridge covering the extraction sites and try to keep them clean and irritant free. The hope is to slow further damage to the bone. Not the news we'd hoped for. It was hard for Gary because it was a bit like the response when I asked about a sleep study for his apnea. "Your prognosis isn't good enough for you to get long-term solutions to other medical issues." There are many things ignored while undergoing palliative care, that wouldn't be otherwise, IMHO. I'm not saying this Dr should try to save Gary's bone that won't heal. It's just another instance of mortality b**ch slapping him in the face.
Beth
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