Side effects on Zometa

[Carol H]

I was receiving Pamindronate for 3 years(every 4 weeks)(Intravenous) but changed recently to Zometa(every 4 wks intravenous also). I also receive weekly Herceptin intravenously and have done for 3 yrs now.(Spread to Bones and right breast(both inoperable)

Does anyone suffer from severe side effects on Zometa - since starting this bone treatment I don't know whether its coincidence or I am starting to go downhill anyway(as I have been 'terminal' for 3 yrs now - but after about 2 weeks of receiving Zometa it wore off and the bone pain gets very bad and feel very nauseas and just plain icky yucky and just not myself and most especially suffer from terrible hot flushes, mostly around the face and upper body(when I read info on Zometa it stated that in some rare cases some women suffer increased sweating) not sure if this is due to the menopause as since my ovaries were removed 3 yrs ago when the cancr came back I was shot right into menopause - would like advice soon as I see my consultant next week(22 Aug) to review treatment and due my bone treatment the same day.

Any thoughts would help as maybe I should switch back to 4 wkly pamidronate(even if it didn't completely mask the bone pain I didn't have all these unpleasant side effects) I need to be 100% as I have 2 kids under the age of 10 and need to be well enough to go about my life as normal as possible.

Hope to get some good advice on this

[Lisa1962]

I have trouble knowing which side effects are from which treatment - because I started them all at the same time - but I do know that I felt HORRIBLE after my first few Zometa infusions and that slowly got better - the flu-like aches and pains subsided for the most part

now all my other symptoms could be from the Herceptin - the sudden pre-mature menopause - theFemara - the Zometa - but they're not debilitating - just incredibly frustrating because I should not feel like I am 94 when I am 44!

you may want to try the Zometa a few more times to see if you get used to it. That being said I have asked to go to an every-other Herceptin treatment for my Zometa. I've just been feeling iffy about the bisphosphates??? did I spell that wrong it looks wrong... and asked if I could skip every other treatment - so I get Herceptin every 3 weeks and Zometa every 6. Yesterday was the first time I skipped the Zometa - and I don't feel like it was and "easier" treatment (just about 20 minutes shorter - yay!). So maybe I am not getting any immediate side effects from the infusions... can't say anything about long-term side effects because I am sure skipping an infusion doesn't get it out of my system.

These decisions are tough - I hope you make one you can feel good about

[heblaj01]

Carole,

According to past studies patients taking Zometa after Pamidronate have a slightly higher rate of side effects than Zometa taken as the first bisphosphonate treatment. If your creatinine is normal (it should be checked before each I.V,) then your kidneys are OK.
Other more common side effects such as feeling of heat in some parts of the body,joint pain,fever,...are the common ones especialy after the first infusion.
Following recommendations from hospital pharmacist & nurses, taking a Tylenol an hour prior to the I.V. & one every 4 to 6 hours for a day has resulted in complete suppression of these symptoms. For subsequent infusions only one pill was taken as a preventative (perhaps unnecessarily).

As an extra precaution you could ask the nurse to set the infusion time at 30 minutes instead of 15. This might provide added protection to the kidneys & reduce some other symptoms.
The original duration in trials was 8 minutes but had to be changed to 15 when a high percentage of kidney problems developed. Since the manufacturer of Zometa wanted to use the short infusion time as a marketing advantage over competing drugs such as Clodronate & Pamidronate it may not have been inclined to set it any longer even though it may be helpfull to a small percentage of patients more prone to side effects.

Finaly a rare but serious side effect is osteonecrosis of the jaw whose risk can be reduced by avoiding dental procedures while taking Zometa.See this post for more info:
http://www.her2support.org/vbulletin...ad.php?t=24978

[heblaj01]

Carole,
Here is an other just reported article on the subject :
Prevention and Management of Side Effects Associated with Bisphosphonates Evaluated
According to an article recently published in the Annals of Oncology, researchers have compiled data and provided suggestions about prevention and management of certain side effects associated with the use of bisphosphonates.

Many patients with advanced cancers experience bone metastases, or spread of cancer to the bones. Bone metastases may ultimately cause debilitating bone pain, bone fractures, spinal compression (a life-threatening condition), and/or abnormalities in calcium levels in the blood; these conditions severely reduce a patient’s quality of life. Treatment for bone metastases is aimed primarily at reducing pain, delaying the time when fractures occur, or reversing hypercalcemia (high levels of calcium in the blood).

Bisphosphonates are a class of drugs used for the treatment of cancer-related hypercalcemia (high levels of calcium in the blood) and of bone metastases in patients with advanced cancers. Bisphosphonates decrease the rate of bone destruction in patients with bone metastases. As well, clinical studies have demonstrated that bisphosphonates can significantly decrease the pain and number of fractures occurring from bone metastases.

The role of bisphosponates has not yet been clearly defined; some researchers believe that bisphosphonates used earlier in the course of cancer may help to prevent bone metastasis. Furthermore, the superiority of one bisphosponate over another has not yet been established. Continuing research is aimed at answering these questions.

Although bisphosphonates are being used in the clinical setting and are being evaluated extensively in clinical trials, the management and risk of side effects associated with their use has not been extensively explored.

Researchers from the H. Lee Moffit Cancer Center and Loyola University recently published suggestions about the management of side effects associated with the intravenous form of bisphosphonates.[*]It is estimated that approximately 2% of patients who receive intravenous bisphosphonates will suffer from serious side effects.

[*]Inflammatory reactions tend to become less frequent with subsequent treatments.
[*]Ocular (eye) inflammation may require therapy to be stopped
[*]Testing of electrolytes should be done prior to administration of therapy.
[*]Patients should undergo a dental exam prior to use of bisphosphonates, as dental problems are associated with a significant increase in the risk of osteonecrosis of the jaw (death of the bone of the jaw).
[*]Patients should not undergo dental procedures while on medication with bisphosphonates.
[*]Monitoring of kidney function should be implemented so that treatment may be discontinued if kidney function becomes abnormal

The researchers concluded that the prevention and/or management of side effects associated with bisphosphonates is important as these agents may provide great relief to patients. Patients should discuss potential side effects and symptoms that may indicate a side effect of therapy; such symptoms should be reported to a healthcare provider.

Reference: Tanvetyznon T and Stiff PJ. Management of the Adverse Effects Associated with Intravenous Bisphosphonates. Annals of Oncology. 2006;17:897-907

[Carol H]

Thanks for the very helpful tips, I will discuss these with my consultant on Tuesday - your advice was very interesting and helpful.