Dear members,
My father (age 70 yrs, type 2 diabetes, arthritis) was diagnosed with multiple myeloma in September 2009. He is currently taking bortezomib [Velcade] and Dexona [dexamethasone] for chemotherapy. His serum creatinine level has started fluctuating between 2.1 to 3.3 and potassium level also went high (7.1) last week.
We consulted the nephrologist and he advised to take K-bind powder to reduce potassium level. Now, potassium level is back to normal, but serum creatinine is still on the higher side (2.7 mg/dl). The oncologist has changed the drug (Zometa [zoledronic acid]) and given Xgeva [denosumab] yesterday. I have read through multiple forums and also on the Myeloma Beacon that this drug is still in the clinical trial phase and not been approved as yet from the FDA.
Please advise whether we should continue with Xgeva or Zometa.
Regards,
Pramod
Forums
2 posts
• Page 1 of 1
Re: Can Xgeva be given to multiple myeloma patients?
Hello from very cold (but at least it's not raining!) Seattle,
As you probably know, Xgeva is not approved for patients with multiple myeloma. It is approved in the U.S. for patients with bone metastases from solid tumors and for the treatment of adults and skeletally mature adolescents with giant cell tumor of bone that is unresectable or where surgical resection is likely to result in severe morbidity. Whether Xgeva is safe and effective in patients with multiple myeloma is not yet proven and is under study.
Zometa can be given in myeloma patients with kidney issues. If I felt strongly that a myeloma patient needed a drug to prevent skeletal fractures, I would tend to stick with the bisphosphonates. The adjustments for Zometa in renal failure are as follows.
Multiple myeloma and bone metastases:
CrCl >60 mL/minute: 4 mg (no dosage adjustment necessary)
CrCl 50-60 mL/minute: Reduce dose to 3.5 mg
CrCl 40-49 mL/minute: Reduce dose to 3.3 mg
CrCl 30-39 mL/minute: Reduce dose to 3 mg
CrCl <30 mL/minute: Use is not recommended.
Aredia is also approved for myeloma and has recommendations for use in patients with renal failure.
Having said all of this, I think it is reasonable to continue the Xgeva, keeping in mind that it is still not approved for myeloma. No dosage adjustment is needed for the Xgeva in renal failure.
As you probably know, Xgeva is not approved for patients with multiple myeloma. It is approved in the U.S. for patients with bone metastases from solid tumors and for the treatment of adults and skeletally mature adolescents with giant cell tumor of bone that is unresectable or where surgical resection is likely to result in severe morbidity. Whether Xgeva is safe and effective in patients with multiple myeloma is not yet proven and is under study.
Zometa can be given in myeloma patients with kidney issues. If I felt strongly that a myeloma patient needed a drug to prevent skeletal fractures, I would tend to stick with the bisphosphonates. The adjustments for Zometa in renal failure are as follows.
Multiple myeloma and bone metastases:
CrCl >60 mL/minute: 4 mg (no dosage adjustment necessary)
CrCl 50-60 mL/minute: Reduce dose to 3.5 mg
CrCl 40-49 mL/minute: Reduce dose to 3.3 mg
CrCl 30-39 mL/minute: Reduce dose to 3 mg
CrCl <30 mL/minute: Use is not recommended.
Aredia is also approved for myeloma and has recommendations for use in patients with renal failure.
Having said all of this, I think it is reasonable to continue the Xgeva, keeping in mind that it is still not approved for myeloma. No dosage adjustment is needed for the Xgeva in renal failure.
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Dr. Edward Libby - Name: Edward Libby, M.D.
Beacon Medical Advisor
2 posts
• Page 1 of 1