Read about denosumab, how you have it and other important information about taking this cancer drug.
Denosumab (pronounced den-oh-sue-mab) is a type of targeted therapy called a monoclonal antibody. It is made in the laboratory to recognise and find specific proteins on the outside of some cells. Denosumab is also known by its brand names, Xgeva and Prolia.
It helps to prevent fractures and other cancer related bone problems in adults with cancer that has spread to the bones.
Prolia can reduce the risk of spinal fractures in men who have weakened bones due to hormone therapy for prostate cancer.
It also helps to slow down bone damage in people who have giant cell tumour of the bone (a non cancerous type of bone tumour).
How it works
In healthy bones, specialised cells constantly break down and replace old tissue. These specialised bone cells are:
- osteoclasts, which break down old bone
- osteoblasts, which build new bone
This process is called bone remodelling and is very well controlled. There is a fine balance between the rates of bone breakdown and growth, which keeps bones strong and healthy.
Denosumab works by targeting a protein called RANKL which controls the activity of osteoclasts. This stops bone cells being broken down and strengthens the bone.
How you have it
You have denosumab as an injection just below the skin (subcutaneously).
Nurse: This is a short film showing you how to give an injection just under your skin. This is called a subcutaneous or sub cut injection. This does not replace what your doctors and nurses tell you, so always follow their advice.
Voiceover: Subcutaneous injections may be part of your cancer treatment. Or, you may need them to prevent side effects of treatment, such as blood clots after surgery. Or to help control cancer symptoms, such as pain or sickness.
Most injections come in prefilled syringes.
Nurse: So, today I am going to show you how to give a subcutaneous injection. I am going to start by giving it into a practice cushion and then you can have a go at giving one yourself. Before you start, you need to get your equipment together. What you are going to need is an alcohol wipe to clean your skin, some cotton wool, a prefilled syringe and a sharps bin. It is important that you wash your hands with soap and water and dry them thoroughly before you start. Check that you have got the correct drug and that it is in date.
You can give the injection into the back of your arm, your tummy, your thigh or the outer part of your bottom. It is important that you vary where you give the injection. So it may be that you give it one day in your tummy and the next in your thigh.
So you start by cleaning the skin with the alcohol wipe and allowing it to air dry. Then you take the cover off the needle and pinch the skin up and hold it a bit like a pen and in an upright position, in a quick dart like motion pop it straight down into the skin. Then you press the plunger right to the end, quickly pull the needle out, dab it with cotton wool, pop the needle into the sharps bin. And then you need to wash your hands again.
So here’s what you are going to need. If you start by checking the drug and the expiry date. And then with the alcohol wipe give your skin a clean. That’s it give it a few seconds for the air to dry it. Okay, and then if you want to pick up the syringe and take the cover off the needle. Then pinch your skin up and at a ninety degree angle gently push the needle in...then press the plunger...and then quickly remove it... dab your skin with the cotton wool and put the syringe in the sharps bin.
When you have it
How often you have denosumab depends on the brand.
You have Xgeva every 4 weeks. If you have giant cell tumour of the bone you have an extra dose 1 week and 2 weeks after the first dose.
You have Prolia every 6 months.
Tests during treatment
You have blood tests before starting treatment and regularly during your treatment. The tests check your levels of calcium and other chemicals in the blood.
Other medicines, foods and drink
Cancer drugs can interact with some other medicines and herbal products. Tell your doctor or pharmacist about any medicines you are taking. This includes vitamins, herbal supplements and over the counter remedies.
This drug contains a type of sugar called sorbitol. If you have an intolerance to some sugars, ask your doctor if it is safe for you to take this drug.
Pregnancy and contraception
This drug may harm a baby developing in the womb. It is important not to become pregnant or father a child while you are having treatment with this drug and for at least 5 months afterwards. Talk to your doctor or nurse about effective contraception before starting treatment.
You may not be able to become pregnant or father a child after treatment with this drug. Talk to your doctor before starting treatment if you think you may want to have a baby in the future. Men may be able to store sperm before starting treatment. Women may be able to store eggs or ovarian tissue but this is rare.
Don’t breastfeed during this treatment because the drug may come through in your breast milk.
Treatment for other conditions
Always tell other doctors, nurses or dentists that you’re having this treatment if you need treatment for anything else, including teeth problems.
Don’t have immunisations with live vaccines while you’re having treatment and for at least 6 months afterwards.
In the UK, live vaccines include rubella, mumps, measles, BCG, yellow fever and Zostavax (shingles vaccine).
- have other vaccines, but they might not give you as much protection as usual
- have the flu vaccine
- be in contact with other people who've had live vaccines as injections
Avoid contact with people who’ve had live vaccines taken by mouth (oral vaccines). This includes the rotavirus vaccine given to babies. The virus is in the baby’s urine for up to 2 weeks and can make you ill. So, you mustn't change their nappies for 2 weeks after their vaccination.
You also need to avoid anyone who has had oral polio or typhoid vaccination recently.
More information about this treatment
For further information about this treatment go to the electronic Medicines Compendium (eMC) website.
You can report any side effect you have to the Medicines Health and Regulatory Authority (MHRA) as part of their Yellow Card Scheme.