Note:
NCCN recognizes that the use of a bisphosphonate (oral/IV) or denosumab is acceptable to maintain or improve bone mineral density and reduce risk of fractures in postmenopausal (natural or induced) individuals receiving adjuvant endocrine therapy.
Note:
Therapy with denosumab (Prolia, Xgeva) is appropriate for continuation when an individual shows stability or improvement in their condition.
Note:
In addition to the above criteria, product specific dosage and/or frequency limits may apply in accordance with the United States Food and Drug Administration (U.S. FDA)-approved product prescribing information, national compendia, Centers for Medicare and Medicaid Services (CMS) and other peer reviewed resources or evidence-based guidelines.
Note:
All individuals should be monitored for hypocalcemia. Denosumab (Prolia, Xgeva) is contraindicated for individuals with hypocalcemia.
Note:
Denosumab (Prolia, Xgeva) is NOT to be used in combination with
ANY
of the following:
-
Parathyroid hormone analogs (e.g., Forteo, Tymlos);
or
- IgG2 monoclonal antibody and sclerostin inhibitor (Evenity).