This leaflet provides information on a course of treatment called Denosumab. The leaflet will explain what this is and when and how it will be given. It will also tell you about common side effects that you may experience. Contact telephone numbers are given at the end of the leaflet.
What is Denosumab?
Denosumab is a drug which helps to strengthen and repair bone damage which is caused by some cancers. It is not a chemotherapy drug. It is one of a group of drugs called monoclonal antibodies. It is given as a subcutaneous injection (just under the surface of the skin).
Why am I having Denosumab?
Your doctor has prescribed Denosumab because it has been found to be effective in patients with cancer that has spread to the bones.
It is most commonly used for:
How will Denosumab be given?
Denosumab is given as a slow subcutaneous injection just under the surface of the skin into the abdomen (tummy), thigh or upper arm.
Will I have to take any other medication?
Most patients will be given Calcium and Vitamin D supplements to take, by mouth, regularly while on Denosumab. It is extremely important that you continue these while on your Denosumab treatment.
Where will my treatment be given?
Denosumab may be given at Velindre, more locally in one of the outreach clinics, or on the mobile chemotherapy unit. We can discuss this further with you.
How long will my appointment take?
You will be allocated approximately half an hour for your appointment time, though the injection itself takes a very short time.
Can I bring relatives and friends with me?
You are welcome to bring someone to stay with you during your treatment. Space is limited so there is not usually room for more than one person. Treatment areas are not suitable for young children.
How often will I receive treatment?
It is usual to have Denosumab treatment once every 4 weeks. However you may have your treatment on day 8 and day 15 in the first month but thereafter your treatment will be every 4 weeks. Your doctor will discuss this with you.
Are there any checks that need to be carried out before starting treatment with Denosumab?
Dental health
Prior to starting Denosumab it is recommended that you have a dental assessment; therefore we recommend that you should visit your dentist to ensure any urgent dental work is completed before you start Denosumab.
You should always tell your dentist that you are receiving Denosumab. You can show them this information leaflet.
It is very important to inform your Consultant if you need dental treatment before starting or during treatment with Denosumab.
Pregnancy and breast-feeding
Denosumab has not been used in pregnant women. It is therefore very important to tell us if you think you may be pregnant, are pregnant, planning a pregnancy or breast feeding.
What are the possible side effects?
This treatment is usually well tolerated but there are some possible side effects that you need to be aware of. The doctors, nurses and pharmacists can give you advice or answer any questions you may have.
Low calcium and phosphate levels
Denosumab is known to lower the blood calcium and phosphate levels; therefore you will have blood tests before starting your treatment. These tests will usually be repeated every three months.
As mentioned earlier in this leaflet you will be given Calcium and Vitamin D supplements. These are extremely important to take while on this medication.
Please tell your doctor, nurse or pharmacist if you have spasms, twitches, or cramps in your muscles, and/or numbness or tingling in your fingers, toes or around your mouth while being treated with Denosumab. These symptoms can be signs of low levels of calcium in your blood.
Rarer side effects
Skin infections
A small number of patients can develop swollen, red areas of skin that feel hot and tender (this is known as cellulitis). Sometimes this can cause fever and chills. If this should happen please see your GP for review. It would also be helpful to let your Velindre Consultant or Specialist Nurse know when you are next in contact with them.
Osteonecrosis of the jaw
Very occasionally, a rare side effect can occur with Denosumab, when there is a breakdown of the jaw bone. It is called osteonecrosis of the jaw and can be a serious condition. Some of the symptoms are:
If you have any of the symptoms listed above or any other dental problems tell your Consultant, Specialist Nurse or Velindre pharmacist.
Is it alright to take other medicines?
If you are taking other medicines please let your Consultant, Specialist Nurse or Velindre pharmacist know.
Sometimes cancer drugs can have very serious side effects which rarely can be life threatening. It is important to inform Velindre cancer centre if you are concerned about any side-effects.
A diagnosis of cancer can increase your risk of developing a blood clot (thrombosis), and having cancer treatment may increase this risk further. It is important to tell your doctor immediately if you have symptoms such as pain, redness and swelling in your leg, or breathlessness and chest pain.
Blood clots can be very serious. However, most clots can usually be successfully treated with drugs to thin the blood. Your doctor or nurse can give you more information
Contact telephone number
Velindre Cancer Centre 029 2061 5888
For urgent advice at any time of the day or night please ask for the treatment helpline
Pharmacy department 029 2061 5888 ext 6223
Monday – Friday 9am – 5pm for queries about your medicines
Tenovus free phone cancer helpline 0808 808 10 10
Manufacturer’s patient information leaflets
Velindre leaflets provide information about very common and common side-effects: for more information regarding the less common side-effects please refer to the manufacturers patient information leaflets, obtained from Velindre pharmacy and/or on the internet at www.medicines.org.uk. Sometimes patients may find these leaflets difficult to read however. Please ask if you would like a copy from your doctor or from Velindre pharmacy
This leaflet was written by health professionals. The information contained in this leaflet is evidence based. It has been approved by doctors, nurses and patients. It is reviewed and updated annually.
Prepared March 2013
Reviewed August 2016