Xgeva (denosumab) is a biologic medicine used to prevent complications from cancer that has spread to the bones (bone metastases), and to treat giant cell tumour of bone. It belongs to a class called RANK ligand (RANKL) inhibitors.

Denosumab blocks a protein called RANKL, which activates osteoclasts (cells that break down bone). In cancer patients with bone metastases, tumour cells stimulate excessive bone destruction by osteoclasts, causing bone pain, fractures, and other skeletal complications. By blocking RANKL, Xgeva reduces osteoclast activity, slowing bone destruction and reducing the risk of these complications.

Note: Xgeva and Prolia contain the same active ingredient (denosumab) but at different doses and for different indications. They must not be substituted for each other.

Xgeva is given as a subcutaneous injection (under the skin) by a healthcare professional, typically in the abdomen, thigh, or upper arm.

The standard dose is 120 mg once every four weeks. For giant cell tumour of bone, additional loading doses may be given in the first month.

Calcium and vitamin D supplements are recommended during treatment unless you have elevated calcium levels (hypercalcaemia).

Your injections are scheduled by your oncology team. Contact them as soon as possible if you need to reschedule.

Contact your oncologist if you have concerns about the dose you received.

Storage is managed by the treating clinic. Vials are stored in a refrigerator between 2°C and 8°C. Do not freeze.

Very common side effects:

• Fatigue
• Nausea
• Low calcium levels (hypocalcaemia): a common and important side effect. Calcium and vitamin D supplementation help prevent this. Symptoms include muscle cramps, tingling or numbness in hands, feet, or around the mouth, and in severe cases, seizures. Calcium levels are monitored regularly
• Low phosphate levels

Serious side effects:

• Osteonecrosis of the jaw (ONJ): a serious but uncommon condition where the jaw bone does not heal properly, usually following dental procedures or trauma. A dental assessment and treatment of any dental problems is recommended before starting Xgeva. Maintain good oral hygiene and avoid invasive dental procedures during treatment where possible. Report any jaw pain, swelling, or tooth loosening
• Atypical femur fractures: rare fractures of the thigh bone, associated with long-term use
• Hypersensitivity reactions

Blood calcium and phosphate levels are checked before each injection.

Xgeva has very few significant drug-drug interactions as a monoclonal antibody. However, combining it with other medicines that affect calcium metabolism (such as corticosteroids or other bisphosphonates) requires monitoring.

Always tell your oncologist about all medicines you are taking.

Why do I need dental checks before starting Xgeva?

Osteonecrosis of the jaw (ONJ) is a known complication of antiresorptive medicines including denosumab. It most commonly occurs after invasive dental procedures (tooth extractions, implants) while on treatment. Pre-treatment dental assessment allows any necessary dental work to be completed before starting Xgeva, when healing is normal. During treatment, good oral hygiene and avoiding unnecessary invasive dental work are the main preventive strategies.

What is the difference between Xgeva and Prolia?

Both contain denosumab, but at different doses for different indications. Prolia is given at 60 mg every six months to treat osteoporosis. Xgeva is given at 120 mg every four weeks to prevent bone complications from cancer and to treat giant cell tumour of bone. They are not interchangeable. Using Xgeva when Prolia is prescribed (or vice versa) would result in a significantly different dose and could cause harm.

Ace provides accurate and independent information medically reviewed on prescription medications. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.