Risk of Jaw Infections with Bone Drugs
There has been a long-standing concern about the vulnerability of some women, with advanced breast cancer who are receiving bone-strengthening drugs, to the possibility of a serious jaw bone infection. I remember first hearing of this a decade or so ago when a woman in my metastatic support group developed this problem. At that time, no one knew what had caused it, and she had to deal with pain, antibiotics, and a lot of uncertainty. Since then, much more has been learned, including some thoughts about who is most at risk. Since the benefit of these drugs is well known, this is another delicate balance between known benefit and possible risk.
From Breast Cancer.org, here is a very thoughtful summary of the problem. I give you the beginning and a link:
CIBD: Bone Drug's Jaw Risk Higher in Some Cancer Patients
What breastcancer.org says about this article..CIBD: Bone Drug's Jaw Risk Higher in Some Cancer Patients
Both Xgeva (chemical name: denosumab) and Zometa (chemical name: zoledronic acid) are approved by the U.S. Food and Drug Administration (FDA) to reduce the risk of bone problems (such as breaking a bone) and bone pain caused by advanced-stage cancer that has spread to the bones.
Xgeva is given as an injection under the skin every 4 weeks. Zometa is given intravenously every 4 weeks. Zometa is a bisphosphonate. Bisphosphonates limit the activity of certain bone cells, called osteoclasts, which help cause the bone weakening and breakdown that leads to osteoporosis. Xgeva is a targeted therapy. Studies have shown that that Xgeva is somewhat better than Zometa at reducing the risk of cancer-related bone problems (called skeletal related events or SREs in the study).
One uncommon but very serious side effect of Xgeva and Zometa (and other bisphosphonates) is jaw bone breakdown, called osteonecrosis of the jaw. Right now, there aren't good treatment options when osteonecrosis of the jaw happens and the condition can be very disabling.
A study that analyzed results from three other studies on the benefits of Xgeva for people with advanced-stage cancer found that people diagnosed with advanced-stage breast or prostate cancer who got Xgeva were about twice as likely to develop osteonecrosis of the jaw compared to people with other advanced-stage cancers who got Xgeva.
Have personal or specific cancer questions that you would like me to answer? Then email me at email@example.com and I'll respond on my Ask Hester blog: