What is Xgeva (denosumab) and who should consider using it?

[Music] what does xgv ordinance am Abin is it a bisphosphonate XG be' is another drug it's also called you know somet it's ranked like an inhibitor that means it neutralizes one of the proteins that activate or still class the bone-eating cells it's given subcutaneously monthly and it's a very convenient and elegant form to gift the dinner somet also patients with renal failure can get in or somet so it's another treatment and patients really like it because they don't have to come for infusions nevertheless you know some up is very expensive and very often insurances give us some problems to gift you know some have for my to the myeloma but that's not only the only reason why I would prefer bisphosphonates we know that you know some that neutralizes rank ligand when you stop you know some that there are still class it's like a hungry cell have an overshooting activity so that means when you stopped in also met we see an increased risk of fractures so that overlapping after the stop of the normal we have to give radio or the mirror bisphosphonates to decrease the activity of the osteoclast you have to keep in mind that after stop of the osteoclast a transition phase in this bisphosphonates is necessary to really decrease activity of osteoclast some of the doctors might not know this so you might expose yourself to an increased risk of fractures after the stop of Dinos oh man so therefore in general the myeloma experts recommend bisphosphonates s the treatment for bone disease and multiple myeloma for instance patients who are resistant to bisphosphonates and develop progressive bone disease despite having this phosphonate treatment should have to know so map or patients who have hypercalcemia that cannot otherwise treated should have to know so map or patients who are in renal failure because you know that it's difficult to give bisphosphonates for patients who have been a failure and you know some web can give independent any renal failure so again to summarize the patients who are treated for my to the melanoma should receive bisphosphonates for two years first year monthly second year every three months in case you have a relapse you should be treated whispers phosphonates you know so map is very expensive and has some issues when you stop you know some app for instance that you might have increased risk of fractures so you had need an overlap of treatment between DiNozzo map and its phosphonates at the end of the treatment burstiness on that also last but not least only a subset of patients who have hypercalcemia that cannot be treated otherwise should receive in also map for patients who have renal failure and are not allowed to receive this phosphonates should have to know [Music]