3 yrs of Zometa.....Then What?

lexislove

Hi ladies!

Hope you dont mind me starting this thread on the Stage lll board, but it seems most Zometa discussions are on here...lol.

I had my 4th Zometa infusion on Wednesday. I have only 2 more to go, July/10 & Jan/11, then Im done.

I always mean to ask my onc, what next but have had other more important things to talk about recently. My questions to anyone is what have your oncs told you?

I know Zometa has a long shelf life...10-15 yrs? But where is that data? the Austrian study that got the ball rolling regarding Zometa, will they be following these woman for another 5 yrs? Total 10 yrs observation.

So as the thread topic says....3yrs Zometa.. Then What?

infohh

Hi

I thought I would be taking the zometa for ever on account of my osteoporsis, if it is only for 3 years what will hapen to the BMD. (I am 50y/o)

HH

Anonymous

Lexi ~  I am due for my second one in March.  Hmmmmm,  I never thougth to ask my onc when I would be finished with them.  I've been taking one treatment step at a time and I guess I'm fearing whats  next so I never ask 

lexislove

Im pre menopausal and on Lupron. My onc gave it to me for prevention of mets and to strngthen my bones to help prevent osteoperosis.

Shana,

For us early stage disease ladies, I think the recommendation is 3 yrs as mets prevention. I dont have osteoperosis, so Im not oz Zometa for life...who knows what the future has in store though.

Although the whole OJ then scares me with Zometa, I dont really think about it being on it for the 3 yrs.....but...I would worry about OJ if I was to do more than 3yrs of Zometa.

everyminute

I wonder if by then the studies on all the orals will be conclusive - you may be on a boniva type drug. 

Where it is exciting to have all these new studies coming out - they are new so we have to kind of go with the flow.

eek

lexislove

eek..lol

Gee, will there ever come a day when I dont have to worry about some pill or injection?!!!! This whole cancer biz is a full time job..Im tellin you.

Husband11

I believe they have followed the women in the Austrian study for approx 8 years now and they are still showing the thirty some percent benefit.  Hopefully by the time your 3 years of zometa treatment ends, we will have 10 year data.  As well, there will be some data from the oral bisphosponates.  As Everyminute says, perhaps it will be suggested that switching to an oral after 3 years will add further benefit?  Wild speculation on my part.  Using an oral bisphosphonate might be suggested if you are on an aromatase inhibitor.  Once again, wild speculation on my part.

KerryMac

I too am hoping by the time my 3 years is up "someone" will have figured out what to do next!

LindaLou53

I completed my 3 years of Zometa last July 2009.  I do not have osteoporosis or osteopenia.  I do not have early stage BC. I do have Stage IIIC locally advanced disease.  My oncologist placed me on Zometa immediately following the completion of my chemo and radiation in 2006 because she was aware of the early study data showing promising results in preventing mets to the bone.  At that time Zometa was typically only given to women with stage IV bone mets and was given on a monthly infusion basis.  We were concerned about the risk of ONJ and I was not comfortable taking the Zometa monthly, so we initially agreed upon every 3 months. I had 6 doses over the first 18 months and then in early 2008 we decided to switch to every 6 months based on further study data becoming available.  I had an additional 3 doses over the next 18 months for 9 doses total by July 2009.

I will be seeing my oncologist next Monday for my 6 month checkup, CXR and tumor markers.  Unless she has new information, we are planning to continue the Zometa on an annual basis and I will receive my 10th dose this coming July.  Neither of us were comfortable going off the Zometa completely given my nodal count, but I am also hopeful that more detailed research will give us answers to the questions about continued benefit, drug half-life and ONJ risk with long term usage.  I plan on picking my onc's brain on this issue Monday so I will let you know if there is any new data regarding staying on Zometa for longer than 3 years.

lexislove

LindaLou,

If you can update on this thread that will be great.

I personally have no problem continuing annual infusions if need be, Im just worried about the risk of ONJ after prolonged usage as well.

thank you..

LindaLou53

Update as requested: 

I saw my onc today for my 6 month checkup.  I asked her if there had been any new research to indicate whether extending zometa infusions for longer than 3 years was advised or discouraged.  She said there was no research data specific to women without mets who took Zometa for longer than 3 years to prevent a recurrence. 

Since I completed 3 years (9 doses) last July, she is still advising me to take a single Zometa dose once a year until further data becomes available. It really is not so much a factor of how many years on Zometa as it is how many doses and how frequent the dosing intervals are.  Women who take Zometa solely for preventing a recurrence or to reverse osteoporosis generally only take infusions twice a year. Whereas women who have Stage IV bone mets generally have infusions every 4 weeks, sometimes for many years. The incidence of side effects seems to be more prevalent in women with frequent intervals and long term (many years) dosing.

I asked her which side effects I should be most concerned about.  She stated that renal issues are really not a worry if there has not been a prior history of renal disease and blood creatinine levels and glomerular filtration rate (GFR) are normal.  She said the biggest concern with Zometa is the change it causes in the bone's ability to heal itself.  No one knows for sure just how long Zometa continues to affect the bone's normal ability to generate new bone growth.  They do know it appears to continue to affect the bones for years, even after the Zometa has been stopped.  She said that anyone taking Zometa should avoid any tooth extractions, dental implants or surgery on the jawbone.  Routine cleanings, fillings, crowns and root canals do not pose a problem as long at the tooth root and jawbone is not disturbed.

So I will get my next Zometa infusion this July.  I always get dental cleanings and checkups every 6 months.  I have had fillings and broken teeth that needed crowns during the time I have been on Zometa and have not had any problems.  I will be scheduling the replacement of several very old silver amalgam fillings over the next couple of years and will plan to do them 10-12 months after my Zometa infusions if that helps at all.  

I have not had a bone density test since before starting Zometa in 2006.  Even though I have been on Aromasin for almost 4 years and it is known to decrease bone density, my onc says that the Zometa will have totally counteracted any affect the Aromasin might have had on my bones.  She feels there is no need to do a bone density test now that I have been on Zometa.

My CXR, blood and tumor marker test results should be available in a few days.  I have every reason to believe that I continue to be NED now 4 years and 1 month out from my Stage 3C dx with 23/23 positive nodes.  My onc says I am her "big success story!" and I want to keep it that way!

P.S.  my onc also mentioned that new research is showing there may be a possible relationship between high blood insulin levels and cancer growth.  It seems that not only do some tumors respond to the presence of hormones in the body, but that high levels of insulin may also "feed"  tumor growth much the same as hormones do in ER/PR + tumors. She said that some discussion is being given to putting cancer patients who have high insulin levels on a diabetic medication called "Metformin"  also known as Glucophage.  They believe that Metformin may have an anti-tumor  affect and could become a drug used for prevention of cancer.

Here is a link to info on a new European study that is forming to look at this issue:

http://www.ncbi.nlm.nih.gov/pubmed/19240238

KerryMac

Linda - thanks for that update. All very interesting stuff.

Congrats on your 4 years too! Amazing! 

lexislove

Thanks linda!

I, myself, was thinking after the 3yrs to just do a yearly infusion....just like a maintenance thing. I was concerned about bone density as well, but my onc said the same as yours, the Zometa would counteract with such. Zometa is really such a great drug to be able to take. Yes, there are risks, but that comes with any medication you were to take. The benefits by far outweigh the risks...

AND....4 years!!!! That is wonderful.