Zometa Question

[Bill]

Anybody out there with bone mets that's receiving Zometa ? My wife receives 4mg. IV per month. Mid-Sept. dose was her third. Her calcium level has stayed steady ( b/w 8.4 - 8.8 mg. / dL ) and her alkaline phosphatase level, which was already high, has INCREASED from 288 ( July ) to 329 this morning ( ref. range : 38 - 126 U/ L ). This appears to be discouraging news or at least confusing news. Anybody that happens to receive Zometa and monitors it's effectiveness via blood tests or other means please share your knowledge.

Thanks much.

[stand4hope]

Bill,

My husband has been receiving Zometa since June (every 4 weeks). I don't have any idea how much he gets, but I will see if I can find out. And, I'm glad you asked about the blood work because he just had blood work done and we met with the onc yesterday for scan results and I forgot to ask for a copy of the blood work. I will get it on Monday and see if I can figure it out and let you know. My husband has had NO side effects from the Zometa at all and since he has numerous and good-sized bone mets that are remaining stable, I assume that the Zometa and Iressa combination are doing their job. I will get back to you on this next week.

Peggy

[Bill]

stand4hope Posted: Sat Sep 25, 2004 6:34 pm Post subject:

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Bill,

My husband has been receiving Zometa since June (every 4 weeks). I don't have any idea how much he gets, but I will see if I can find out. And, I'm glad you asked about the blood work because he just had blood work done and we met with the onc yesterday for scan results and I forgot to ask for a copy of the blood work. I will get it on Monday and see if I can figure it out and let you know. My husband has had NO side effects from the Zometa at all and since he has numerous and good-sized bone mets that are remaining stable, I assume that the Zometa and Iressa combination are doing their job. I will get back to you on this next week.

Peggy

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Peggy :

Thanks. I will watch for it. I'm particularly interested in the level and trend for relevant blood values like calcium amd alkaline phosphatase. It's my understanding that the alkaline phosphatase level in a post-menopausal woman ( my wife is 57 yo ) is normally higher than males and younger females but I don't know how significant that factor is. But, that aside, it has been my understanding that with my wife's condition both the blood-calcium and alkaline phoshpatase levels should be high and Zometa should bring them down. As you can see, my wife's blood calcium isn't high at 8.4 ~ 8.8 ( ref. range : 8.4 - 10.2 ) and really isn't moving one way or the other. Her alkaline phosphatase level is high ( 329 U/L ) and it's not dropping despite the Zometa therapy. It's actually gone up a little ! BTW, her blood values related to liver function are within normal limits. So, this has got to be a bone-related issue. Discouraged and confused about this scenario.

[lisaRN]

Dear Bill

From my experience the normal range of alkaline phosphatase is 30-120 U/L in an adult.... my reference shows no difference between male and female reference ranges..

The maximum dosage for Zometa is 4mg given by IV infusion over no less than 15 minutes. 4 mg seems to be the standard dosing information.

Drugs that may cause elevated ALP levels include albumin made from placental tissue, allopurinol, antibiotics, azathioprine, colchicine, fluorides, indomethacin, isoniazid (INH), methotrexate, methyldopa, nicotinic acid, phenothiazine, probenecid, tetracyclines, and verapamil.

Other things that can cause increased levels are cirrhosis, primary or metastatic liver tumor, biliary obstruction, metastatic tumor to the bone, healing fracture, hyperparathyroidism, sarcoidosis, and rheumatoid arthritis.

Does your wife have liver mets? I am assuming she has bone mets if she is taking the Zometa. Perhaps the bone mets are the cause for the increase.

My husband has mets to bone, liver, adrenal gland and brain....he is on Zometa (got 2nd dose yesterday).... I will let you know what his levels are when i get them on monday....

so far we dont think he is having any side effects from Zometa itself....but sometimes there is so much going on with symptoms it is difficult to sort it all out...

Prayers for you and your wife....

WITH EVERY DIFFICULTY ~ THERE IS RELIEF................LISA

[stand4hope]

I found my husband's blood test results from a physical taken where he is employed. This was drawn on 8/4/04 and he would have had two iv infusions of Zometa (and I'm assuming 4 mg.):

Calcium: In range at 9.0 (reference range 8.5-10.4 MG/DL)

Alkaline Phosphatase: In range at 82 (reference range 20-125 U/L)

[Bill]

stand4hope Posted: Sat Sep 25, 2004 8:08 pm Post subject:

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I found my husband's blood test results from a physical taken where he is employed. This was drawn on 8/4/04 and he would have had two iv infusions of Zometa (and I'm assuming 4 mg.):

Calcium: In range at 9.0 (reference range 8.5-10.4 MG/DL)

Alkaline Phosphatase: In range at 82 (reference range 20-125 U/L)

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Peggy :

Now the plot really thickens ! To me your husband's Ca and ALP levels look like great news. Given his more recent Bio entries I'd expect at least his ALP level to be much higher more like my wife's. My wife MAY have a spot on her liver but they can't see it very well due to the metal in her spine. At least so far her liver isn't considered an issue ( and her latest related blood values are within normal limits ). It's her bone mets. My wife's ALP level has steadily climbed since starting Zometa ( 288 - 317 - 329 ). Her Ca level, slightly less than your husband's, is just sitting there at the lower end of the ref. range. A very confusing picture. Until somebody explains otherwise, I would consider your husband's results very good news. And, if his progress ( or lack of ) elsewhere doesn't match I'd certainly be asking these treating physicians for a sensible medical explanation.

[kimblanchard]

Bill, don't put too much into those lab tests. Alkaline phosphatase is an enzyme found in the bones and liver, in your wife's case I'm assuming it's coming from the bones (you can do a test that will tell which it's coming from but probably not worth doing). Zometa will not usually bring the alk phos down so it is not a sign that it is not working. The alk phos is being released because of the cancer's effects on the bones and it would be a responsibility of the cancer treatment (i.e. chemo, iressa, etc) to bring that effect under control. Zometa basically strengthens the bones and makes them less susceptible to fracture, also makes them a less hospitable environment for the cancer to grow in. In fact, it can indirectly cause the alk phos to go up if the bones are trying to heal themselves. But it doesn't really have direct anti-cancer effects. Likewise, Zometa will bring down calcium levels if they are too high but it is not supposed to make the levels low (although that does happen sometimes as a side effect).

So the fact that the alk phos is going up does not mean the Zometa is not doing what it is supposed to do. Why is the alk phos going up? That I can't say but that enzyme is commonly elevated for lots of different reasons and needs to be taken into context with everything else going on.

[Bill]

oncodoc Posted: Sun Sep 26, 2004 9:30 am Post subject:

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Bill, don't put too much into those lab tests. Alkaline phosphatase is an enzyme found in the bones and liver, in your wife's case I'm assuming it's coming from the bones (you can do a test that will tell which it's coming from but probably not worth doing). Zometa will not usually bring the alk phos down so it is not a sign that it is not working. The alk phos is being released because of the cancer's effects on the bones and it would be a responsibility of the cancer treatment (i.e. chemo, iressa, etc) to bring that effect under control. Zometa basically strengthens the bones and makes them less susceptible to fracture, also makes them a less hospitable environment for the cancer to grow in. In fact, it can indirectly cause the alk phos to go up if the bones are trying to heal themselves. But it doesn't really have direct anti-cancer effects. Likewise, Zometa will bring down calcium levels if they are too high but it is not supposed to make the levels low (although that does happen sometimes as a side effect).

So the fact that the alk phos is going up does not mean the Zometa is not doing what it is supposed to do. Why is the alk phos going up? That I can't say but that enzyme is commonly elevated for lots of different reasons and needs to be taken into context with everything else going on.

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Dr. Joe :

Thanks much for the explanation.

P.S. It sometimes makes me wonder why the oncologists and other treating physicians even bother ordering these lab tests. I have not only seen these reports filed and unread by the Dr. but in one instance involving my wife a notoriously unreliable blood value in chemo patients ( platelet count ) was used by another Dr. ( who was aware that she was rec. chemo ) as a sole basis for treating a non-existent infection.

[Bill]

oncodoc Posted: Sun Sep 26, 2004 9:30 am Post subject:

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Bill, don't put too much into those lab tests. Alkaline phosphatase is an enzyme found in the bones and liver, in your wife's case I'm assuming it's coming from the bones (you can do a test that will tell which it's coming from but probably not worth doing). Zometa will not usually bring the alk phos down so it is not a sign that it is not working. The alk phos is being released because of the cancer's effects on the bones and it would be a responsibility of the cancer treatment (i.e. chemo, iressa, etc) to bring that effect under control. Zometa basically strengthens the bones and makes them less susceptible to fracture, also makes them a less hospitable environment for the cancer to grow in. In fact, it can indirectly cause the alk phos to go up if the bones are trying to heal themselves. But it doesn't really have direct anti-cancer effects. Likewise, Zometa will bring down calcium levels if they are too high but it is not supposed to make the levels low (although that does happen sometimes as a side effect).

So the fact that the alk phos is going up does not mean the Zometa is not doing what it is supposed to do. Why is the alk phos going up? That I can't say but that enzyme is commonly elevated for lots of different reasons and needs to be taken into context with everything else going on.

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I sure hope so. My wife's alkaline phosphatase level has been steadily increasing. A week ago it was measured at 399. Her blood calcium level continues to hover in the 8.2 ~ 8.5 range.

[Don Wood]

My wife took Zometa for about a year and then was switched to Aredia, which does the same thing -- builds bone and helps prevent further bone mets. She has been on that for about six months. I see that oncodoc answered what I was surmising, and that is: the alkaline phosphatase might go up because of bone repair (activity). I know that the PSA for prostate cancer will go up if anything stimulates or attacks the prostate, having nothing to do with the tumor. Not to worry. Don