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ask: What are some alternatives to bisphosphonates for someone with breast cancer which has metastisized to the bones?

Do you know any drugs (or alternative therapies) that might help strengthen bones in someone who can no longer take bisphosphonates? My sister has breast cancer that has metastisized to her bones. She was getting bisphosphonates (injected) but now has necrosis of the jaw.

Add a Comment8 Comments

Pat Elliott

Hi jtmkjm and Sharon - Here is information from today's New York Times that may be of interest.
Pat

November 18, 2010, 8:38 pm

F.D.A. Approves a Bone Drug for Cancer Patients
By ANDREW POLLACK

The Food and Drug Administration on Thursday approved the use of Amgen’s bone drug denosumab as a treatment for cancer patients whose disease has spread to their bones.
The drug, which will be called Xgeva, does not treat the cancer itself. Rather, it helps prevent fractures, spinal cord compression or other bone problems that can arise as cancers weaken the bones.

Denosumab, which is considered crucial to Amgen’s future, was approved in June as a treatment for osteoporosis in post-menopausal women. It is sold for that purpose under the name Prolia. Sales so far have been slow.
But the use for cancer patients might be more lucrative for Amgen because cancer patients will use 12 times as much of the drug a year than osteoporosis patients do. Sales could easily surpass $1 billion a year, some analysts estimate.
The wholesale price of Xgeva will be $1,650 for an injection given every four weeks, the company said.

Amgen needs strong sales of denosumab because growth is slowing for its now mature portfolio of other products. And sales of its anemia drug Aranesp have fallen over the last few years because of safety concerns.

Bone metastases are quite common, particularly for advanced prostate, breast and lung cancer. For patients with advanced prostate cancer, bone metastases are the dominant cause of death and symptoms, said Dr. Matthew R. Smith, a prostate cancer specialist at the Massachusetts General Hospital Cancer Center.

Amgen tested Xgeva directly against Novartis’s Zometa, which is already approved to prevent bone problems in cancer patients. Xgeva proved superior in prostate and breast cancer in reducing the risk of fractures, spinal cord compression or the need for surgery or radiation treatment for bone problems.

For other solid tumors Xgeva was roughly equivalent to Zometa. But Xgeva did not work well in multiple myeloma, a cancer of the bone marrow, so it is not approved for patients with that cancer or other blood and lymphatic cancers.
Amgen, the world’s largest biotechnology company, is also testing whether denosumab could actually prevent the spread of cancer to the bone in the first place. There is no drug approved for that purpose. Results of that trial are expected before the end of this year.

November 18, 2010 - 8:10pm
Pat Elliott

Hi Sharon - It's so nice to hear from you, and thanks for your kind words. I'm glad the diet and exercise are helping you, what you're dealing with isn't easy. We have a lot of good information on the site for cancer patients, both in our cancer section and breast cancer section. One of our HERWriters that I've personally found very helpful and inspiring is Annette Mattern, who is both a breast cancer and ovarian cancer survivor. You can find her profile here: http://www.empowher.com/users/annette-leal-mattern

Please feel free to get in touch at any time. If you want to use the email system to send a private, direct message, please do. And let me know what your doctor says as that information may help another woman in the future.

Take care,
Pat

July 24, 2010 - 11:24am
jtmkjm

Thank you so much Pat. I appreciate all your hard work. We'll follow up on all your links and talk with her doctor about prolia and forteo. Thanks for forwarding anything else you come across. Good luck to you with your health. Have a wonderful weekend!

July 23, 2010 - 10:58am
Sharon G (reply to jtmkjm)

Hi Pat,
I am jtmkjm's sister. I wanted to thank you for your help personally. When I searched I found nothing to give me hope but diet and exercise(which has already changed dramatically). I have been pretty low lately with the bone pain, but you have given me some hope. I will talk with my doctor at Wednesday appointment about these options.
Thanks again,
Sharon G

July 24, 2010 - 10:56am
Pat Elliott

Hi again jtmkjm - I was able to get some recommendations from fellow patients.

* Prolia, an injectable (twice a year). Has been used successfully for men with prostate mets to the pelvic bones. Newly approved for postmenopausal women for high risk osteoporosis. It's a monocolonal antibody. Like Fosomax, it also stops/slows bone loss.

http://www.latimes.com/news/health/la-he-closer-20100614,0,5979690.story
http://www.prolia.com/
http://www.webmd.com/osteoporosis/news/20100602/fda-approves-prolia-for-...
http://en.wikipedia.org/wiki/Denosumab

* Forteo, daily injectable. It's a recombinant form of parathyroid hormone. It actually builds bone. Downside is prolonged treatment gives a slight increase to osteosarcoma risk (at least in rats) so is used as a second line treatment and is limited to two years of maximum use.

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000227
http://www.medicinenet.com/script/main/art.asp?articlekey=21853
http://www.forteo.com/Pages/index.aspx
http://en.wikipedia.org/wiki/Teriparatide

Let me know if I can help you further. Pat

July 22, 2010 - 9:17pm
Pat Elliott

You're welcome. Have you discussed this with her oncologist?

I'm finding some alternative suggestions, such as eating a healthy diet, but am pretty sure that's not what you're looking for. I'm also finding some suggestions that appear to be scams. I'm a breast cancer survivor myself, and a leukemia patient, and am hoping that digging deeper into some clinical resources or perhaps even some of the clinical trials data will shed more light on this.

You should get a notice via email when there are any responses to your question. I know you have a lot on your mind, and didn't want you to think you had to keep checking. Take care.

July 22, 2010 - 6:57pm
jtmkjm

Thanks, Pat.
I'll keep checking back.

July 22, 2010 - 6:50pm
Pat Elliott

Hi jtmkjm and thanks for your question on behalf of your sister.

In terms of the jaw necrosis, a study done by Cornell in 2006 says that in some In cases acrylic stents (cavity supports) - with or without soft liners - may benefit exposed bone. Gentle surgical debridement (cleaning away of dead areas of bone) may also help, and oral antimicrobial rinses are frequently used as well.

In terms of an alternative to bisphosphonates for her, I've searched several clinical references and resources, but they have all referred to bisphosphonates as the standard of treatment. I will do some additional research, and if I'm able to find more suggestions I will post them for you.

Please let us know if we can help you in any other way.
Take care,
Pat

July 22, 2010 - 6:37pm
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