Indications

Xgeva

Hypercalcemia of Malignancy (see Hypercalcemia

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Prevention of Skeletal-Related Events (Pathologic Fractures, Need for XRT/Surgery to Bone, Spinal Cord Compression) in Metastatic Bone Disease Due to Solid Tumors

• Breast Cancer (see Breast Cancer)
• Prostate Cancer (see Prostate Cancer)

Prolia

Prevention of Post-Menopausal Osteoporosis

• Osteoporosis (see Osteoporosis)

Treatment of Men Receiving Androgen Therapy in Non-Metastatic Prostate Cancer

• Prostate Cancer (see Prostate Cancer)

Treatment of Women Receiving Aromatase Inhibitor Therapy in Breast Cancer

• Breast Cancer (see Breast Cancer)

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Contraindications

• Hypocalcemia (see Hypocalcemia)
• Pregnancy (see Pregnancy)

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Pharmacology

Receptor Activator of Nuclear Factor-κB Ligand (RANKL) Inhibitor

• IgG2 Monoclonal Antibody which Prevents RANKL (CD254) from Activating its Receptor, RANK (CD265), on Surface of Osteoclasts (and Pre-Osteoclasts)
  • Mimics the function of osteoprotegerin -> inhibits osteoclast formation, function, and survival -> inhibits osteoclast bone resorption
  • Net effect: increased trabecular and cortical bone mass and strength
• Other Potential Immunomodulatory Effects: related to the observations that RANKL is present on T-cells and that RANK is present on dendritic cells

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Administration

• SQ (Xgeva): 120 mg q4wks
  • Half-Life: 28 days
• Renal Dose-Adjustment:
• Hepatic Dose-Adjustment:

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Adverse Effects

Renal Adverse Effects

• Hypocalcemia (see Hypocalcemia): fatal cases have been reported
• Hypophosphatemia (see Hypophosphatemia)
• Osteonecrosis of the Jaw

Other Adverse Effects

• Atypical Femoral Fractures
• Teratogenicity
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References

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