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Xgeva (denosumab) is a medication used primarily to prevent skeletal-related events in patients with bone metastases from solid tumors. It is also used for treating giant cell tumor of bone, hypercalcemia of malignancy, and multiple myeloma. Xgeva works by inhibiting the receptor activator of nuclear factor kappa-Β ligand (RANKL), a protein involved in bone breakdown. It is administered as a 120 mg subcutaneous injection every four weeks. Pros:
  1. Effective Bone Protection: Xgeva is highly effective in preventing bone fractures and other skeletal-related events in patients with bone metastases.
  2. Convenient Dosing: Administered once every four weeks, it allows for less frequent dosing compared to some other treatments.
  3. Alternative to Zoledronic Acid: For patients who cannot tolerate bisphosphonates like zoledronic acid, Xgeva offers an effective alternative.
  1. Side Effects: Common side effects include hypocalcemia (low blood calcium levels), nausea, diarrhea, and fatigue. Serious side effects can include osteonecrosis of the jaw, severe infections, and allergic reactions​ .
  2. Cost: Xgeva is expensive. The price for a single 120 mg injection is around $3,194.48 in the United States​ ​.
  3. Risk of Osteonecrosis of the Jaw: Patients must take precautions regarding dental health, as this medication increases the risk of severe jaw bone damage.
Price Comparison:
  • US Prices: The cost for one 120 mg injection of Xgeva is approximately $3,194.48​ (Drugs.com)​.
  • International Prices: Prices may vary internationally, and some patients may find lower prices through international pharmacies or assistance programs.
Patient Assistance Programs:
  • Amgen SupportPlus Co-Pay Program: Eligible patients with commercial insurance may pay as little as $0 per dose, subject to an annual maximum benefit​​.
  • Amgen Safety Net Foundation: Provides free or reduced-cost medication to eligible uninsured or underinsured patients​ ​.
In summary, Xgeva is a potent medication for preventing skeletal complications in cancer patients with bone metastases. Despite its effectiveness and convenient dosing schedule, its high cost and potential for serious side effects, particularly related to bone health, are significant considerations for patients and healthcare providers. Patients are encouraged to explore assistance programs to help manage the financial burden.
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