Zolodronic Acid (Zometa) and Dental Surgery

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wewooster
wewooster Member Posts: 6
edited June 2014 in DCIS (Ductal Carcinoma In Situ)

Hi,

I was told by my medical oncologist that Zolodronic Acid (ZA) which is administered as an infusion be taken every 6 months and this would help prevent the recurrence of breast cancer.  I've already had one recurrence in 2008.   I didn't had any adjuvant therapy after the second surgery for the recurrence even though I had planned brachytherapy and to take an aromatase inhibitor (AI).  I had an infection in my breast after surgery which prohibited getting the radiation and have not yet had the oopherectomy in order to go into menopause so I could start the AI.

The research has not been deemed sufficient about ZA (Zometa) yet to be covered by the government drug plan (I live in Canada).  So I purchased it myself.  It cost $700.  I was just about to take it when I found out I had to have dental surgery.  Because the drug is a Bisphosphonate it can weaken the bone in the jaw slowing down the healing process or it could lead to much worse like the destruction of the bone.  My dental surgeons (I got several opinions) all told me to not take the drug if I have the surgery. 

This drug treatment is still in the research stages although all indications seem to say it will reduce recurrence by almost 40%.  My medical oncologist is still encouraging me to take it (wait 3 months then have the dental surgery). A second opinion from another medical oncologist told me this drug treatment is not proven yet and with the potential side effect I should NOT take the risk.  Meanwhile I have this drug which will expire in Jan 2011.  I have put off the dental surgery until I can figure things out.

Have any of you taken Zometa AND has dental surgery?  Have you had side effects or complications?  Do you have any suggestions?  Thanks.

 

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  • hrf
    hrf Member Posts: 3,225
    edited September 2010

    I have had 2 tx of the Zometa and had no se at all. I have had a couple of fillings but no major dental surgery. Access Zometa is covering 50% of the cost.

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  • wewooster
    wewooster Member Posts: 6
    edited September 2010

    Thanks for your response.  I had not heard of Access Zometa.  I will contact them on Monday.  I believe the problem with Zometa is if you are doing dental work that involves the bone.  In my case I will have to have teeth extracted and implants inserted. 

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  • sling99
    sling99 Member Posts: 106
    edited September 2010

    Do you know how long will it take for you to fully heal from the dental surgery? I would  not postpone the dental surgery too long if it something you must have done. Can you safely take the zometa after you are healed? Hopefully it won't be expired by then.

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  • wewooster
    wewooster Member Posts: 6
    edited September 2010

    Hi Sling99,

    I actually bought the Zometa earlier this year around Jan 2010 this is why the expiry date is about 1 year from time of purchase.  It will take about a year to go through the entire process of pulling out the teeth then waiting for it to heal and then doing the implants.  I've had tooth absesses for quite a while dating back to 2008 but they have come and gone.  The last dental surgeon I consulted with said to wait until it absessed again before proceeding although the longer I wait I think the bone loss continues and I may need more bone grafting come surgery time.  So I've been waiting but of course the clock is ticking for the Zometa and may have lost that window at this point unless I go with my current medical oncologist who says to take the drug and do the surgery 3 months after.  I also am not sure I'd want to take it after the dental surgery either since if I happen to need more surgery then I am stuck again.  If you look at pictures of what can happen when you do take a Bisphosphonate and you get the jaw bone side effect its pretty gruesome.  I think its more likely to get it with frequent use of Zometa though.  Its quite confusing the whole thing but thanks so much for responding.  I am very glad I joined this forum.

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  • wewooster
    wewooster Member Posts: 6
    edited October 2010

    I called Access Zometa (Canada) and they indicated that you can apply for financial assistance if your income is less than 50K.  You need to provide proof of this which probably means you would need to submit your tax form or assessment. Also they will only reimburse you if its been a month since you purchased the drug.  In my case its been several months but the person I spoke to told me to apply anyways and they will review the case.  There is one form to fill out and I haven't seen it yet since it was faxed to my doctor directly but supposedly there is a portion to be filled out by you and a portion for your doctor. The agent also said that once your application is submitted it would take 24-48 hours for them to make a decision.

     

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  • OneBadBoob
    OneBadBoob Member Posts: 1,386
    edited October 2010

    Wewooster--

    I had lots of dental work done about ten years ago, including many implants and have had no problems.

    Before starting Zometa every six months (two years ago) I spoke with my dentist, and he told me that he would never had done any implants or extractions if I had been on Zometa at that time.

    He advises women to complete any and all necessary dental work and have it full healed before starting  Zometa.

    He also wants me in for cleanings every three months, and tells me to take meticulous care of my teeth now that I am on Zometa.

    Just my $.02 worth.

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  • wewooster
    wewooster Member Posts: 6
    edited October 2010

    To One Bad Boob,

     Very catchy name by the way :-))  I appreciate your comments.

     Last night I started getting a lot of pain in the problem tooth.  Maybe my body is trying to tell me something!  Most likely the drug will expire before I figure out what to do.

     If you or anyone has any suggestions on what to do with this drug let me know.

     Right now the only option I see is to donate to research.

     

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  • sgreenarch
    sgreenarch Member Posts: 528
    edited October 2010

    Hi. I've been proscribed Zometa once I get clearance from my dentist. HAH! (Easier said than done.) I have terrible teeth and gums, and this is forcing me to deal with these problems (that I honestly put off) all at once. Dentists do freak out even when saying the word "Zometa," and now I need some extractions even prophylactically as no one is willing to say that I won't have major periodontal disease during the next two years (the course of Zometa given by IV every 6 mos.) Kind of feel like I'm in a catch-22 but I do want to take the drug, and I'm getting lots of dental opinions (saying 'Zometa' gets you in to see the deans of dental schools!) The questions is, and I know I should ask my onc, which I will, can I wait 6 months after mastectomy to take the medicine? Had my surgery in July and by the time all is healed, it will probably be December. I know I shouldn't complain, but all this dental hysteria and work is driving me a bit crazy. Just want to know if anyone has had a similar experience. Thanks.

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  • wewooster
    wewooster Member Posts: 6
    edited October 2010

    Hi Sgreenarch:

     You have the same serious concerns that I do.  I've obtained some great comments and advice from forum participants but I think what it comes down to is getting the information from medical oncologists who know the facts of your case.  I would suggest getting more than one opinion as well.

      I may be totally off base here but I am not sure why your current oncologist is suggesting Zometa for you given that you are having a mastectomy.  Zometa is to prevent recurrence of breast cancer in the afftected breast and a mastectomy will reduce recurrence by about 99%.

      Also from what I have heard the research is very promising about Zometa for breast cancer but it has not been completed.  This is why the drug is not being covered in Canada as a drug for breast cancer.  It is only approved for bone cancer.

      There is also some recent data indicating Zolodronic Acid can cause esophageal cancer.

      Even in my case where I already had one recurrence and was not able to have adjuvant therapy until now (1 year after surgery) my oncologists are not saying this is mandatory treatment.

      I just read a Review article 2008 on use of Bisphosphonate intravenous vs oral and those who take it intravenously are more likely (94%) to get ONJ (osteonecrosis of the jaw) than those who take it orally. Also those who were more likely to get ONJ were those with cancer (variety of forms including breast) (94%).In 69% of the cases ONJ was incited by a tooth extraction or some other dental surgery whereas in 20% ONJ was spontaneous.

      If your dental situation is as bad as it seems then I would definitely take care of that first.  Dental surgery is pretty traumatic too.  Given you will have this and a mastectomy maybe you don't want to add more complications.

     

      

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  • sgreenarch
    sgreenarch Member Posts: 528
    edited October 2010

    Hi, Wewooster, thanks for the reply. I had a mastectomy on the left side only and my onc seems to feel Zometa is worthwhile for the other side (I guess.) I met with a periodontist last night who seems convinced that we can take care of most of my dental problems within the next month and then safely start the Zomera. I would love to know more about how often bc patients have bad side effects from this drug. Thanks, though. I'll keep you posted if I learn more.

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