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Veeraballi S, Bandaru SS, Kiwan C, Chan KH, Shaaban HS. A multifaceted role of bisphosphonates from palliative care to anti-cancer therapy in solid tumors. J Oncol Pharm Pract 2024:10781552241265304. [PMID: 39056232 DOI: 10.1177/10781552241265304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
INTRODUCTION Bisphosphonates (P-C-Ps) also called diphosphonates are the structural analogs of naturally occurring pyrophosphates. Bisphosphonates are traditionally used and shown to provide long-term success in the treatment and prevention of osteoporosis and other bone loss pathologies. Furthermore, bisphosphonates are gaining popularity in the present era of cancer therapeutics and prevention. The usage of bisphosphonates as adjuvant or neoadjuvant therapy, either as a single agent or combined with other chemotherapy, has been studied in different solid tumors. This review aims to present the various roles of bisphosphonates in solid tumors. DATA SOURCES Articles in MEDLINE/PubMed and the National Institutes of Health Clinical Trials Registry (http://www. Clinicaltrials.gov) between 1 January 2011 and 1 February 2022 were extracted using MeSH terms "bisphosphonates/diphosphosphonates and mechanism," "bisphosphonates and breast cancer," "bisphosphonates and prostate cancer," "bisphosphonates and lung cancer," "bisphosphonates and cancer risk," and "bisphosphonates and adverse events." Manual searches of some major oncology journals were also conducted. DISCUSSION This review article focuses on the antitumor activity of bisphosphonates, safety profile, and the role of bisphosphonates as preventive, neoadjuvant, and adjuvant chemotherapy. A significant improvement in overall survival and cancer-specific survival and recurrence-free survival with the usage of bisphosphonates is noted in breast cancer patients, particularly in post-menopausal women. Though great progress has been achieved in over 20 years, further research is needed to identify the subgroup of patients that are most likely to benefit from adjuvant bisphosphonate therapy and to determine regimens with greater efficacy and better safety profile.
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Affiliation(s)
| | | | - Chrystina Kiwan
- Saint Michael's Medical Center, Internal Medicine Residency, Newark, NJ, USA
| | - Kok Hoe Chan
- McGovern Medical School, University of Texas Health Science Center at Houston, Houston, USA
| | - Hamid S Shaaban
- Saint Michael's Medical Center, Hematology Oncology, Newark, NJ, USA
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Fuleihan GEH, Drake MT. Commentary on the endocrine society clinical practice guideline on the "treatment of hypercalcemia of malignancy in adults". Metabolism 2023; 143:155553. [PMID: 37028591 DOI: 10.1016/j.metabol.2023.155553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 03/21/2023] [Accepted: 03/28/2023] [Indexed: 04/09/2023]
Affiliation(s)
- Ghada El-Hajj Fuleihan
- Calcium Metabolism and Osteoporosis Program, World Health Organization Collaborating Center for Metabolic Bone Disorders, American University of Beirut, Beirut 1107 2020, Lebanon.
| | - Matthew T Drake
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN 55902, USA
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El-Hajj Fuleihan G, Clines GA, Hu MI, Marcocci C, Murad MH, Piggott T, Van Poznak C, Wu JY, Drake MT. Treatment of Hypercalcemia of Malignancy in Adults: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab 2023; 108:507-528. [PMID: 36545746 DOI: 10.1210/clinem/dgac621] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Hypercalcemia of malignancy (HCM) is the most common metabolic complication of malignancies, but its incidence may be declining due to potent chemotherapeutic agents. The high mortality associated with HCM has declined markedly due to the introduction of increasingly effective chemotherapeutic drugs. Despite the widespread availability of efficacious medications to treat HCM, evidence-based recommendations to manage this debilitating condition are lacking. OBJECTIVE To develop guidelines for the treatment of adults with HCM. METHODS A multidisciplinary panel of clinical experts, together with experts in systematic literature review, identified and prioritized 8 clinical questions related to the treatment of HCM in adult patients. The systematic reviews (SRs) queried electronic databases for studies relevant to the selected questions. The Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to assess the certainty of evidence and make recommendations. An independent SR was conducted in parallel to assess patients' and physicians' values and preferences, costs, resources needed, acceptability, feasibility, equity, and other domains relevant to the Evidence-to-Decision framework as well as to enable judgements and recommendations. RESULTS The panel recommends (strong recommendation) in adults with HCM treatment with denosumab (Dmab) or an intravenous (IV) bisphosphonate (BP). The following recommendations were based on low certainty of the evidence. The panel suggests (conditional recommendation) (1) in adults with HCM, the use of Dmab rather than an IV BP; (2) in adults with severe HCM, a combination of calcitonin and an IV BP or Dmab therapy as initial treatment; and (3) in adults with refractory/recurrent HCM despite treatment with BP, the use of Dmab. The panel suggests (conditional recommendation) the addition of an IV BP or Dmab in adult patients with hypercalcemia due to tumors associated with high calcitriol levels who are already receiving glucocorticoid therapy but continue to have severe or symptomatic HCM. The panel suggests (conditional recommendation) in adult patients with hypercalcemia due to parathyroid carcinoma, treatment with either a calcimimetic or an antiresorptive (IV BP or Dmab). The panel judges the treatments as probably accessible and feasible for most recommendations but noted variability in costs, resources required, and their impact on equity. CONCLUSIONS The panel's recommendations are based on currently available evidence considering the most important outcomes in HCM to patients and key stakeholders. Treatment of the primary malignancy is instrumental for controlling hypercalcemia and preventing its recurrence. The recommendations provide a framework for the medical management of adults with HCM and incorporate important decisional and contextual factors. The guidelines underscore current knowledge gaps that can be used to establish future research agendas.
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Affiliation(s)
| | - Gregory A Clines
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Mimi I Hu
- Department of Endocrine Neoplasia and Hormonal Disorders, University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
| | - Claudio Marcocci
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa 56100, Italy
| | - M Hassan Murad
- Evidence-based Practice Center, Mayo Clinic, Rochester, MN 55905, USA
| | - Thomas Piggott
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, L8S 4K1, Canada
- MacGRADE Centre, McMaster University, Hamilton, ON, L8S 4K1, Canada
- Department of Family Medicine, Queens University, Kingston, ON, K7L 3G2, Canada
- Peterborough Public Health, Peterborough, ON, K9J 2R8, Canada
| | - Catherine Van Poznak
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI 48109, USA
| | - Joy Y Wu
- Department of Medicine, Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Matthew T Drake
- Department of Internal Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Tzotzas T, Goropoulos A, Karras S, Terzaki A, Siolos A, Doumas A, Zaramboukas T, Tigas S. Effective long-term management of parathyromatosis-related refractory hypercalcemia with a combination of denosumab and cinacalcet treatment. Hormones (Athens) 2022; 21:171-176. [PMID: 34993886 DOI: 10.1007/s42000-021-00343-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 12/07/2021] [Indexed: 11/24/2022]
Abstract
Parathyromatosis is a rare cause of persistent or recurrent primary hyperparathyroidism and hypercalcemia due to the presence of hyperfunctioning foci of parathyroid tissue in the neck and/or mediastinum. We describe the case of a male patient who presented with severe hypercalcemia and a left-sided palpable parathyroid mass. Over the course of the next 18 years, the patient underwent neck exploration surgery on multiple occasions due to recurrent primary hyperparathyroidism and refractory hypercalcemia, complicated by nephrolithiasis and impairment of renal function, while bone mineral density was preserved. Histological findings and the natural course of the disease were consistent with parathyromatosis. Medical interventions with oral bisphosphonates or high-dose cinacalcet failed to control the patient's hypercalcemia. The combination of monthly denosumab and cinacalcet was, however, successful in maintaining the patient's serum calcium in the normal/upper-normal range over a 36-month period with no significant side effects. This is the first report of off-label denosumab use in combination with cinacalcet in the long-term management of parathyromatosis-related refractory hypercalcemia.
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Affiliation(s)
| | | | - Spyridon Karras
- Postdoctoral Researcher-National Scholarship Foundation, Thessaloniki, Greece
| | - Alexandra Terzaki
- Department of Endocrinology, University of Ioannina, Ioannina, Greece
| | - Athanasios Siolos
- Department of Endocrinology, University of Ioannina, Ioannina, Greece
| | - Argyrios Doumas
- Nuclear Medicine Department, AHEPA University Hospital, Thessaloniki, Greece
| | | | - Stelios Tigas
- Department of Endocrinology, University of Ioannina, Ioannina, Greece
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Saito Y, Uchiyama K, Sakamoto T, Yamazaki K, Kubota K, Takekuma Y, Komatsu Y, Sugawara M. [Pharmaceutical Intervention According to Strict Management System Can Normalize Decreased Serum Calcium Level by Denosumab and Prevent Its Aggravation]. YAKUGAKU ZASSHI 2021; 141:1023-1030. [PMID: 34334547 DOI: 10.1248/yakushi.21-00055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Denosumab is a fully monoclonal antibody against the receptor activator of nuclear factor kappa-B ligand (RANKL), and prevents skeletal-related events by bone metastasis. Hypocalcemia is the most typical adverse effect of denosumab use. We have developed a management system for the more efficient and safer management of denosumab administration, and evaluated pharmaceutical interventions for the better control of hypocalcemia. All pharmaceutical interventions in the system from April 2016 to March 2020 were retrospectively evaluated. We have also assessed the incidence of hypocalcemia in 158 patients who were administered denosumab for six months or more in the period. A total of 282 pharmaceutical interventions (7.0% of the total administration) were conducted. The most conducted intervention was regarding hypocalcemia, which involved the suspension of the injection and/or the increase of calcium and vitamin D supplement with 65% adoption and 17% temporary treatment suspensions. Other interventions were about hypercalcemia, request of laboratory examination and ordering supplements, dental consultation, and poor renal function. A total of 199 interventions (70.6%) were adopted, with 33 administrations suspended. The frequency of hypocalcemia was 27.8% with just one patient having grade 2 hypocalcemia, suggesting that there were no severe cases. Moreover, hypocalcemia was significantly normalized following pharmaceutical intervention and/or handling by physicians (p=0.02) according to the system. Conversely, the normalization rate in hypercalcemia did not differ according to the countermeasures. In conclusion, pharmaceutical interventions according to our management system benefit safe denosumab treatment, especially in severe hypocalcemia prevention.
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Affiliation(s)
| | | | | | | | - Kosei Kubota
- Department of Pharmacy, Hokkaido University Hospital
| | - Yoh Takekuma
- Department of Pharmacy, Hokkaido University Hospital
| | | | - Mitsuru Sugawara
- Department of Pharmacy, Hokkaido University Hospital.,Laboratory of Pharmacokinetics, Faculty of Pharmaceutical Sciences, Hokkaido University
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Shacham EC, Marshak DC, Brikman S, Dori G, Ishay A. Severe hypercalcemia in a patient with chronic lymphocytic leukemia and non-small cell lung carcinoma: A case report. Medicine (Baltimore) 2021; 100:e24982. [PMID: 33832072 PMCID: PMC8036102 DOI: 10.1097/md.0000000000024982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Hypercalcemia is a common finding in patients with advanced-stage cancers. Paraneoplastic hypercalcemia is commonly associated with dismal prognoses, with survival rates of about 3 months. In this paper, we report on a patient with advanced chronic lymphocytic leukemia and non-small cell lung carcinoma who developed severe hypercalcemia and discuss the diagnosis and treatment of this metabolic complication. PATIENT CONCERNS A 56-year old male with a 2-year history of Rai stage IV chronic lymphocytic leukemia presented with life-threatening hypercalcemia. Positron emission tomography/computed tomography revealed a suspicious lung lesion. A transbronchial biopsy was performed from the upper left lobe. Due to the small size of the specimen, immunohistochemical markers were performed and revealed positive staining for cytokeratin 7 and negative for TTF-1, napsin A and p 40, which were consistent with non-small cell lung carcinoma. DIAGNOSIS Humoral hypercalcemia of malignancy was diagnosed. INTERVENTION The patient was treated with saline infusion, calcitonin, intravenous pamidronate, followed with denosumab. OUTCOMES The hypercalcemia was successfully treated and the patient's calcium levels returned to normal. Further evaluation revealed a non-small cell lung carcinoma as a second primary malignancy. The patient was treated with venetoclax for his refractory CLL and received chemotherapy and immunotherapy for lung adenocarcinoma. Several days after starting venetoclax, he developed Legionella pneumonia and short time after the second course of chemotherapy, a severe sepsis occurred and he passed away. LESSONS Coexistence of 2 unrelated malignancies, whichever could be a reason for hypercalcemia of malignancy is a rare event. Severe hypercalcemia, which is possible but rare feature of CLL should be a reason for further prompt evaluation.
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MESH Headings
- Carcinoma, Non-Small-Cell Lung/chemically induced
- Carcinoma, Non-Small-Cell Lung/complications
- Carcinoma, Non-Small-Cell Lung/diagnostic imaging
- Carcinoma, Non-Small-Cell Lung/pathology
- Fatal Outcome
- Humans
- Hypercalcemia/etiology
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/drug therapy
- Lung Neoplasms/pathology
- Male
- Middle Aged
- Neoplasms, Second Primary/diagnostic imaging
- Neoplasms, Second Primary/pathology
- Positron Emission Tomography Computed Tomography
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Affiliation(s)
- Elena Chertok Shacham
- Department of Internal Medicine E, HaEmek Medical Center
- Endocrinology Unit, HaEmek Medical Center
| | | | - Shay Brikman
- Department of Internal Medicine E, HaEmek Medical Center
- Faculty of medicine, Technion – Israel Institute of Technology, Haifa, Israel
| | - Guy Dori
- Department of Internal Medicine E, HaEmek Medical Center
- Faculty of medicine, Technion – Israel Institute of Technology, Haifa, Israel
| | - Avraham Ishay
- Endocrinology Unit, HaEmek Medical Center
- Faculty of medicine, Technion – Israel Institute of Technology, Haifa, Israel
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Levin AS, Alcorn SR, Neuman BJ, Meyer CF. Team Approach: Emergencies in Patients with Skeletal Metastases. JBJS Rev 2019; 7:e8. [PMID: 30920480 DOI: 10.2106/jbjs.rvw.18.00036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Affiliation(s)
- Adam S Levin
- Department of Orthopaedic Surgery (A.S.L. and B.J.N.), Department of Radiation and Molecular Radiation Sciences (S.R.A.), Sidney Kimmel Comprehensive Cancer Center (C.F.M.), The Johns Hopkins School of Medicine, Baltimore, Maryland
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9
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Ishchenko Y, Shakirzyanova A, Giniatullina R, Skorinkin A, Bart G, Turhanen P, Määttä JA, Mönkkönen J, Giniatullin R. Selective Calcium-Dependent Inhibition of ATP-Gated P2X3 Receptors by Bisphosphonate-Induced Endogenous ATP Analog ApppI. J Pharmacol Exp Ther 2017; 361:472-481. [PMID: 28404687 DOI: 10.1124/jpet.116.238840] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 04/07/2017] [Indexed: 12/30/2022] Open
Abstract
Pain is the most unbearable symptom accompanying primary bone cancers and bone metastases. Bone resorptive disorders are often associated with hypercalcemia, contributing to the pathologic process. Nitrogen-containing bisphosphonates (NBPs) are efficiently used to treat bone cancers and metastases. Apart from their toxic effect on cancer cells, NBPs also provide analgesia via poorly understood mechanisms. We previously showed that NBPs, by inhibiting the mevalonate pathway, induced formation of novel ATP analogs such as ApppI [1-adenosin-5'-yl ester 3-(3-methylbut-3-enyl) triphosphoric acid diester], which can potentially be involved in NBP analgesia. In this study, we used the patch-clamp technique to explore the action of ApppI on native ATP-gated P2X receptors in rat sensory neurons and rat and human P2X3, P2X2, and P2X7 receptors expressed in human embryonic kidney cells. We found that although ApppI has weak agonist activity, it is a potent inhibitor of P2X3 receptors operating in the nanomolar range. The inhibitory action of ApppI was completely blocked in hypercalcemia-like conditions and was stronger in human than in rat P2X3 receptors. In contrast, P2X2 and P2X7 receptors were insensitive to ApppI, suggesting a high selectivity of ApppI for the P2X3 receptor subtype. NBP, metabolite isopentenyl pyrophosphate, and endogenous AMP did not exert any inhibitory action, indicating that only intact ApppI has inhibitory activity. Ca2+-dependent inhibition was stronger in trigeminal neurons preferentially expressing desensitizing P2X3 subunits than in nodose ganglia neurons, which also express nondesensitizing P2X2 subunits. Altogether, we characterized previously unknown purinergic mechanisms of NBP-induced metabolites and suggest ApppI as the endogenous pain inhibitor contributing to cancer treatment with NBPs.
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Affiliation(s)
- Yevheniia Ishchenko
- A. I. Virtanen Institute (Y.I., A.Sh., Rai.G., G.B., Ras.G.) and School of Pharmacy (P.T., J. M.), University of Eastern Finland, Kuopio, Finland; Kazan Institute of Biochemistry and Biophysics, Kazan, Russia (A.Sh., A.Sk.); Institute of Biomedicine, University of Turku, Turku, Finland (J.A.M.); and Kazan Federal University, Kazan, Russia (A.Sh., A.Sk., R.Gas.)
| | - Anastasia Shakirzyanova
- A. I. Virtanen Institute (Y.I., A.Sh., Rai.G., G.B., Ras.G.) and School of Pharmacy (P.T., J. M.), University of Eastern Finland, Kuopio, Finland; Kazan Institute of Biochemistry and Biophysics, Kazan, Russia (A.Sh., A.Sk.); Institute of Biomedicine, University of Turku, Turku, Finland (J.A.M.); and Kazan Federal University, Kazan, Russia (A.Sh., A.Sk., R.Gas.)
| | - Raisa Giniatullina
- A. I. Virtanen Institute (Y.I., A.Sh., Rai.G., G.B., Ras.G.) and School of Pharmacy (P.T., J. M.), University of Eastern Finland, Kuopio, Finland; Kazan Institute of Biochemistry and Biophysics, Kazan, Russia (A.Sh., A.Sk.); Institute of Biomedicine, University of Turku, Turku, Finland (J.A.M.); and Kazan Federal University, Kazan, Russia (A.Sh., A.Sk., R.Gas.)
| | - Andrei Skorinkin
- A. I. Virtanen Institute (Y.I., A.Sh., Rai.G., G.B., Ras.G.) and School of Pharmacy (P.T., J. M.), University of Eastern Finland, Kuopio, Finland; Kazan Institute of Biochemistry and Biophysics, Kazan, Russia (A.Sh., A.Sk.); Institute of Biomedicine, University of Turku, Turku, Finland (J.A.M.); and Kazan Federal University, Kazan, Russia (A.Sh., A.Sk., R.Gas.)
| | - Genevieve Bart
- A. I. Virtanen Institute (Y.I., A.Sh., Rai.G., G.B., Ras.G.) and School of Pharmacy (P.T., J. M.), University of Eastern Finland, Kuopio, Finland; Kazan Institute of Biochemistry and Biophysics, Kazan, Russia (A.Sh., A.Sk.); Institute of Biomedicine, University of Turku, Turku, Finland (J.A.M.); and Kazan Federal University, Kazan, Russia (A.Sh., A.Sk., R.Gas.)
| | - Petri Turhanen
- A. I. Virtanen Institute (Y.I., A.Sh., Rai.G., G.B., Ras.G.) and School of Pharmacy (P.T., J. M.), University of Eastern Finland, Kuopio, Finland; Kazan Institute of Biochemistry and Biophysics, Kazan, Russia (A.Sh., A.Sk.); Institute of Biomedicine, University of Turku, Turku, Finland (J.A.M.); and Kazan Federal University, Kazan, Russia (A.Sh., A.Sk., R.Gas.)
| | - Jorma A Määttä
- A. I. Virtanen Institute (Y.I., A.Sh., Rai.G., G.B., Ras.G.) and School of Pharmacy (P.T., J. M.), University of Eastern Finland, Kuopio, Finland; Kazan Institute of Biochemistry and Biophysics, Kazan, Russia (A.Sh., A.Sk.); Institute of Biomedicine, University of Turku, Turku, Finland (J.A.M.); and Kazan Federal University, Kazan, Russia (A.Sh., A.Sk., R.Gas.)
| | - Jukka Mönkkönen
- A. I. Virtanen Institute (Y.I., A.Sh., Rai.G., G.B., Ras.G.) and School of Pharmacy (P.T., J. M.), University of Eastern Finland, Kuopio, Finland; Kazan Institute of Biochemistry and Biophysics, Kazan, Russia (A.Sh., A.Sk.); Institute of Biomedicine, University of Turku, Turku, Finland (J.A.M.); and Kazan Federal University, Kazan, Russia (A.Sh., A.Sk., R.Gas.)
| | - Rashid Giniatullin
- A. I. Virtanen Institute (Y.I., A.Sh., Rai.G., G.B., Ras.G.) and School of Pharmacy (P.T., J. M.), University of Eastern Finland, Kuopio, Finland; Kazan Institute of Biochemistry and Biophysics, Kazan, Russia (A.Sh., A.Sk.); Institute of Biomedicine, University of Turku, Turku, Finland (J.A.M.); and Kazan Federal University, Kazan, Russia (A.Sh., A.Sk., R.Gas.)
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von Borstel D, A Taguibao R, A Strle N, E Burns J. Giant cell tumor of the bone: aggressive case initially treated with denosumab and intralesional surgery. Skeletal Radiol 2017; 46:571-578. [PMID: 28188337 DOI: 10.1007/s00256-017-2588-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Revised: 01/11/2017] [Accepted: 01/25/2017] [Indexed: 02/02/2023]
Abstract
Giant cell tumor of the bone (GCTB) is a locally aggressive benign tumor, which has historically been treated with wide surgical excision. We report a case of a 29-year-old male with histology-proven GCTB of the distal ulna. The initial imaging study was a contrast-enhanced magnetic resonance imaging (MRI) examination of the left wrist, which was from an outside facility performed before presenting to our institution. On the initial MRI, the lesion had homogenous T2-hyperintense and T1-hypointense signal with expansive remodeling of the osseous contour. A radiographic study performed upon presentation to our institution 1 month later showed progression of the lesion with atypical imaging characteristics. After confirming the diagnosis, denosumab therapy was implemented allowing for reconstitution of bone and intralesional treatment. The patient was treated with five doses of denosumab over the duration of 7 weeks. Therapeutic changes of the GCTB were evaluated by radiography and a post-treatment MRI. This MRI was interpreted as suspicious for worsening disease due to the imaging appearance of intralesional signal heterogeneity, increased perilesional fluid-like signal, and circumferential cortical irregularity. However, on subsequent intralesional curettage and bone autografting 6 weeks later, no giant cells were seen on the specimen. Thus, the appearance on the MRI, rather than representing a manifestation of lesion aggressiveness or a non-responding tumor, conversely represented the imaging appearance of a positive response to denosumab therapy. On follow-up evaluation, 5 months after intralesional treatment, the patient had recurrent disease and is now scheduled for wide-excision with joint prosthesis.
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Affiliation(s)
- Donald von Borstel
- Department of Radiology, Oklahoma State University Medical Center, 744 W 9th Street, Tulsa, OK, 74127, USA.
| | - Roberto A Taguibao
- Department of Pathology, University of California, Irvine, UCI Medical Center, 101 The City Dr. South, Route 140, Orange, CA, 92868, USA
| | - Nicholas A Strle
- Department of Radiology, Oklahoma State University Medical Center, 744 W 9th Street, Tulsa, OK, 74127, USA
| | - Joseph E Burns
- Department of Radiological Sciences, University of California, Irvine, UCI Medical Center, 101 The City Dr. South, Route 140, Orange, CA, 92868, USA
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11
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Emergencies in Breast Cancer. Breast Cancer 2017. [DOI: 10.1007/978-3-319-48848-6_58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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12
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Gastanaga VM, Schwartzberg LS, Jain RK, Pirolli M, Quach D, Quigley JM, Mu G, Scott Stryker W, Liede A. Prevalence of hypercalcemia among cancer patients in the United States. Cancer Med 2016; 5:2091-100. [PMID: 27263488 PMCID: PMC4899051 DOI: 10.1002/cam4.749] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 03/04/2016] [Accepted: 03/16/2016] [Indexed: 12/11/2022] Open
Abstract
Hypercalcemia of malignancy (HCM) is a serious metabolic complication whose population‐based prevalence has not been quantified. Rates of HCM differ by tumor type, with highest rates reported in multiple myeloma and lowest among colorectal and prostate cancer patients. This analysis estimates HCM prevalence in the US. This retrospective study used the Oncology Services Comprehensive Electronic Records (OSCER) warehouse of electronic health records (EHR) including laboratory values from 569000 patients treated at 565 oncology outpatient sites. OSCER data were projected to the national level by linking EHR to claims data. Cancer patients included were ≥18 years, and had serum calcium (Ca) and albumin (for corrected serum Ca [CSC]) records. Period prevalence was estimated by HCM CTCAE grade, tumor type, and year (2009–2013). Estimates were adjusted to capture patients diagnosed with HCM outside oncology practices based on a subset of patients linkable to office and hospital data. The analysis included 68023 (2009) to 121482 (2013) cancer patients. In 2013, patients with HCM had a median of six Ca tests, 69.7% had chemotherapy, and 34% received bone modifying agents. HCM rates were highest for multiple myeloma patients (7.5% [2012]–10.2% [2010]), lowest for prostate cancer (1.4% [2012]–2.1% [2011]).The estimated adjusted annual prevalence of HCM from 2009 to 2013 was 95441, 96281, 89797, 70158, and 71744, respectively. HCM affected 2.0–2.8% of all cancer patients. EHR data from oncology clinics were critical for this study because these data contain results from laboratory studies (i.e., serum calcium values) that are routinely ordered in that setting. We estimated that the prevalence of HCM in the US in 2013 is 71744, affecting approximately 2% of cancer patients overall. This percentage differs by tumor type and appears to have decreased over the five‐year study period.
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Affiliation(s)
| | | | | | | | - David Quach
- PRA Health Sciences, Blue Bell, Pennsylvania
| | | | - George Mu
- Glaxo Smith Kline, Collegeville, Pennsylvania
| | - W Scott Stryker
- Amgen Inc., Thousand Oaks and South San Francisco, California
| | - Alexander Liede
- Amgen Inc., Thousand Oaks and South San Francisco, California
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Irelli A, Cocciolone V, Cannita K, Zugaro L, Di Staso M, Lanfiuti Baldi P, Paradisi S, Sidoni T, Ricevuto E, Ficorella C. Bone targeted therapy for preventing skeletal-related events in metastatic breast cancer. Bone 2016; 87:169-75. [PMID: 27091227 DOI: 10.1016/j.bone.2016.04.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 03/04/2016] [Accepted: 04/06/2016] [Indexed: 10/21/2022]
Abstract
Cancer cells can alter physiological mechanisms within bone resulting in high bone turnover, and consequently in skeletal-related events (SREs), causing severe morbidity in affected patients. The goals of bone targeted therapy, as bisphosphonates and denosumab, are the reduction of incidence and the delay in occurrence of the SREs, to improve quality of life and pain control. The toxicity profile is similar between bisphosphonates and denosumab, even if pyrexia, bone pain, arthralgia, renal failure and hypercalcemia are more common with bisphosphonates, while hypocalcemia and toothache are more frequently reported with denosumab. Osteonecrosis of the jaw (ONJ) occurred infrequently without statistically significant difference. The present review aims to provide an assessment on bone targeted therapies for preventing the occurrence of SREs in bone metastatic breast cancer patients, critically analyzing the evidence available so far on their effectiveness, in light of the different mechanisms of action. Thus, we try to provide tools for the most fitting treatment of bone metastatic breast cancer patients. We also provide an overview on the usefulness of bone turnover markers in clinical practice and new molecules currently under study for the treatment of bone metastatic disease.
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Affiliation(s)
- Azzurra Irelli
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy.
| | - Valentina Cocciolone
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Katia Cannita
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy
| | - Luigi Zugaro
- Radiology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy
| | - Mario Di Staso
- Radiation Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy
| | - Paola Lanfiuti Baldi
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy
| | - Stefania Paradisi
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Tina Sidoni
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy
| | - Enrico Ricevuto
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
| | - Corrado Ficorella
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, 67100 L'Aquila, Italy; Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100 L'Aquila, Italy
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14
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Mohammad KS, Guise TA. Hypercalcemia of Malignancy: A New Twist on an Old Problem. J Oncol Pract 2016; 12:435-6. [PMID: 27170692 DOI: 10.1200/jop.2016.012062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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15
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Hishida E, Masuda T, Akimoto T, Sato R, Wakabayashi N, Miki A, Otani N, Imai T, Sugase T, Takeda SI, Muto S, Nagata D. Renal Failure Found during the Follow-up of Sarcoidosis: The Relevance of a Delay in the Diagnosis of Concurrent Hypercalcemia. Intern Med 2016; 55:1893-8. [PMID: 27432099 DOI: 10.2169/internalmedicine.55.6194] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein present a case of relapsed sarcoidosis with a deteriorated renal function accompanied by hypercalcemia, nephrolithiasis, and a ureteral stone in a woman with a history of ocular sarcoidosis. The ocular involvement appeared to be well controlled for a long period of time with a topical ophthalmic steroid; however, we believe that the absence of apparent recrudescence could have led to the delay in our diagnosis of relapse of the disease during the follow-up period. The conundrums regarding longitudinal surveillance for both evaluating the disease activity and determining the necessity of therapeutics are also discussed.
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Affiliation(s)
- Erika Hishida
- Division of Nephrology, Department of Internal Medicine, Jichi Medical University, Japan
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16
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Mirrakhimov AE. Hypercalcemia of Malignancy: An Update on Pathogenesis and Management. NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2015; 7:483-93. [PMID: 26713296 PMCID: PMC4683803 DOI: 10.4103/1947-2714.170600] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Hypercalcemia of malignancy is a common finding typically found in patients with advanced stage cancers. We aimed to provide an updated review on the etiology, pathogenesis, clinical presentation, and management of malignancy-related hypercalcemia. We searched PubMed/Medline, Scopus, Embase, and Web of Science for original articles, case reports, and case series articles focused on hypercalcemia of malignancy published from 1950 to December 2014. Hypercalcemia of malignancy usually presents with markedly elevated calcium levels and therefore, usually severely symptomatic. Several major mechanisms are responsible for the development of hypercalcemia of malignancy including parathyroid hormone-related peptide-mediated humoral hypercalcemia, osteolytic metastases-related hypercalcemia, 1,25 Vitamin D-mediated hypercalcemia, and parathyroid hormone-mediated hypercalcemia in patients with parathyroid carcinoma and extra parathyroid cancers. Diagnosis should include the history and physical examination as well as measurement of the above mediators of hypercalcemia. Management includes hydration, calcitonin, bisphosphonates, denosumab, and in certain patients, prednisone and cinacalcet. Patients with advanced underlying kidney disease and refractory severe hypercalcemia should be considered for hemodialysis. Hematology or oncology and palliative care specialists should be involved early to guide the options of cancer targeted therapies and help the patients and their closed ones with the discussion of comfort-oriented care.
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Affiliation(s)
- Aibek E Mirrakhimov
- Department of Medicine, University of Kentucky School of Medicine, 800 Rose Street, Lexington, KY 40536, USA
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17
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Jumpertz von Schwartzenberg R, Elbelt U, Ventz M, Mai K, Kienitz T, Maurer L, Rose T, Rückert JC, Strasburger CJ, Spranger J. Palliative treatment of uncontrollable hypercalcemia due to parathyrotoxicosis: denosumab as rescue therapy. Endocrinol Diabetes Metab Case Rep 2015; 2015:150082. [PMID: 26605043 PMCID: PMC4653612 DOI: 10.1530/edm-15-0082] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 10/29/2015] [Indexed: 11/08/2022] Open
Abstract
Parathyroid carcinoma is a rare disease leading to severe hypercalcemia due to hyperparathyroidism. Surgery is the primary treatment option. A more progressive form of the disease is characterized by parathyrotoxicosis, and subsequent hypercalcemia is the most common cause of death. We report a case presenting with severe hypercalcemia due to parathyrotoxicosis from parathyroid carcinoma treated for the first time using the monoclonal antibody denosumab as a rescue therapy and present long-term follow-up data. The 71-year-old patient presented with severe hypercalcemia due to metastatic parathyroid carcinoma. Despite undergoing treatment with bisphosphonates, cinacalcet hydrochloride, and forced diuresis, the patient`s condition deteriorated rapidly due to resistant hypercalcemia. Surgery performed because of spinal metastasis and forced diuresis lowered calcium levels, albeit they remained in the hypercalcemic range and significantly increased when forced diuresis was stopped. Considering a palliative situation to overcome hypercalcemia, we decided to administer denosumab, a monoclonal antibody that binds to the receptor activator of nuclear factor-kappa B ligand. After a single subcutaneous administration of 60 mg denosumab, calcium levels normalized within one day. Subsequent denosumab injections led to permanent control of serum calcium for more than 2 years despite rising parathyroid hormone levels and repeated surgeries. Together with recent cases in the literature supporting our observation, we believe that denosumab is relevant for future trials and represents an effective tool to control hypercalcemia in patients with advanced stages of parathyroid cancer.
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Affiliation(s)
| | - Ulf Elbelt
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Manfred Ventz
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Knut Mai
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Tina Kienitz
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Lukas Maurer
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Thomas Rose
- Division of Rheumatology and Clinical Immunology, Medical Department, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Jens C Rückert
- Department of General Visceral Vascular and Thoracic Surgery, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Christian J Strasburger
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
| | - Joachim Spranger
- Department of Endocrinology and Metabolic Diseases, Charité - Universitätsmedizin , Charitéplatz 1, Berlin, 10117 , Germany
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Yamashita Y, Ukai T, Nakamura H, Yoshinaga Y, Kobayashi H, Takamori Y, Noguchi S, Yoshimura A, Hara Y. RANKL pretreatment plays an important role in the differentiation of pit-forming osteoclasts induced by TNF-α on murine bone marrow macrophages. Arch Oral Biol 2015; 60:1273-82. [PMID: 26099662 DOI: 10.1016/j.archoralbio.2015.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Revised: 04/22/2015] [Accepted: 06/03/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Osteoclasts differentiated from bone marrow macrophages (BMMs) induced by TNF-α alone do not have resorbing activity. When BMMs are stimulated with receptor activator of NF-κB ligand (RANKL) before TNF-α stimulation, pit-forming osteoclasts are differentiated. However, the details of the effect of RANKL pretreatment on the pit-forming osteoclast differentiation by TNF-α have not been established. The aim of this study is to examine the condition of RANKL pretreatment for differentiation of pit-forming osteoclasts induced by TNF-α. Murine BMMs were stimulated with various concentrations of RANKL for 24h in the presence of M-CSF, then the medium was changed and TNF-α was added. Osteoclasts and pits formation were examined. Osteoprotegerin (OPG), decoy receptor of RANKL, was added to the culture to examine the necessity of co-existing RANKL with TNF-α on the formation of pit-forming osteoclasts. To investigate the influence of RANKL of sufficient concentration as pretreatment for pit-forming osteoclast formation by TNF-α, dose- and time-dependent changes of osteoclast formation were checked. RESULTS The pit formation by osteoclasts in response to TNF-α required 10ng/mL RANKL pretreatment. Stimulation with this concentration of RANKL led to the differentiation of mature osteoclasts in the 72h culture. The pit formation was not inhibited by the OPG. CONCLUSION These results suggested that the concentration of RANKL pretreatment, which also alone can differentiate BMMs into osteoclasts, may be important in the differentiation of pit-forming osteoclasts by TNF-α. In addition, the effects of TNF-α after RANKL treatment might be independent of RANKL.
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Affiliation(s)
- Yasunori Yamashita
- Department of Periodontology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Takashi Ukai
- Department of Periodontology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
| | - Hirotaka Nakamura
- Department of Periodontology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yasunori Yoshinaga
- Department of Periodontology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Hiroki Kobayashi
- Department of Periodontology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yuzo Takamori
- Department of Periodontology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Satoshi Noguchi
- Department of Periodontology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Atsutoshi Yoshimura
- Department of Periodontology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
| | - Yoshitaka Hara
- Department of Periodontology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan
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19
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Traitements inhibiteurs de la résorption osseuse en situation métastatique : bilan actuel et perspectives. ONCOLOGIE 2015. [DOI: 10.1007/s10269-015-2494-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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20
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Adhikaree J, Newby Y, Sundar S. RE: Denosumab for patients with persistent or relapsed hypercalcemia of malignancy despite recent bisphosphonate treatment. J Natl Cancer Inst 2015; 107:dju509. [PMID: 25663690 DOI: 10.1093/jnci/dju509] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Jason Adhikaree
- Academic Oncology Department, Nottingham City Hospital, Nottingham, UK (JA, YN, SS).
| | - Yvette Newby
- Academic Oncology Department, Nottingham City Hospital, Nottingham, UK (JA, YN, SS)
| | - Santhanam Sundar
- Academic Oncology Department, Nottingham City Hospital, Nottingham, UK (JA, YN, SS)
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21
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Meng QH, Wagar EA. Laboratory approaches for the diagnosis and assessment of hypercalcemia. Crit Rev Clin Lab Sci 2014; 52:107-19. [DOI: 10.3109/10408363.2014.970266] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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22
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Lawlor PG, Bush SH. Delirium in patients with cancer: assessment, impact, mechanisms and management. Nat Rev Clin Oncol 2014; 12:77-92. [DOI: 10.1038/nrclinonc.2014.147] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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23
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Hu MI, Glezerman IG, Leboulleux S, Insogna K, Gucalp R, Misiorowski W, Yu B, Zorsky P, Tosi D, Bessudo A, Jaccard A, Tonini G, Ying W, Braun A, Jain RK. Denosumab for treatment of hypercalcemia of malignancy. J Clin Endocrinol Metab 2014; 99:3144-52. [PMID: 24915117 PMCID: PMC4154084 DOI: 10.1210/jc.2014-1001] [Citation(s) in RCA: 92] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Accepted: 05/21/2014] [Indexed: 12/29/2022]
Abstract
CONTEXT Hypercalcemia of malignancy (HCM) in patients with advanced cancer is often caused by excessive osteoclast-mediated bone resorption. Patients may not respond to or may relapse after iv bisphosphonate therapy. OBJECTIVE We investigated whether denosumab, a potent inhibitor of osteoclast-mediated bone resorption, reduces serum calcium in patients with bisphosphonate-refractory HCM. DESIGN, SETTING, AND PARTICIPANTS In this single-arm international study, participants had serum calcium levels corrected for albumin (CSC) >12.5 mg/dL (3.1 mmol/L) despite bisphosphonates given >7 and ≤30 days before screening. INTERVENTION Patients received 120 mg sc denosumab on days 1, 8, 15, and 29 and then every 4 weeks. MAIN OUTCOME MEASURES The primary endpoint was the proportion of patients with CSC ≤11.5 mg/dL (2.9 mmol/L) (response) by day 10. Secondary endpoints included response by visit, duration of response, and the proportion of patients with a complete response (CSC ≤10.8 mg/dL [2.7 mmol/L]) by day 10 and during the study. RESULTS Patients (N = 33) had solid tumors or hematologic malignancies. By day 10, 21 patients (64%) reached CSC ≤11.5 mg/dL, and 12 patients (33%) reached CSC ≤10.8 mg/dL. During the study, 23 patients (70%) reached CSC ≤11.5 mg/dL, and 21 patients (64%) reached CSC ≤10.8 mg/dL. Estimated median response duration was 104 days. The most common serious adverse events were hypercalcemia worsening (5 patients, 15%) and dyspnea (3 patients, 9%). CONCLUSIONS In patients with HCM despite recent iv bisphosphonate treatment, denosumab lowered serum calcium in 64% of patients within 10 days, inducing durable responses. Denosumab may offer a new treatment option for HCM.
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Affiliation(s)
- Mimi I Hu
- University of Texas, MD Anderson Cancer Center (M.I.H.), Houston, Texas 77030; Memorial Sloan-Kettering Cancer Center and Weill Cornell Medical College (I.G.G.), New York, New York 10065; Institut Gustave Roussy (S.L.), Villejuif, France; Yale School of Medicine (K.I.), New Haven, Connecticut 06510; Montefiore Medical Center-Bronx (R.G.), New York, New York 10467; Endocrinology Department, Medical Center for Postgraduate Education (W.M.), Warsaw, Poland; Lee Moffitt Cancer Center and Research Institute (B.Y.), Tampa, Florida 33607; Peninsula Regional Medical Center (P.Z.), Salisbury, Maryland 21801; Institut Régional du Cancer de Montpellier-Val d'Aurelle (D.T.), Montpellier, France; California Cancer Associates for Research and Excellence (A.B.), Encinitas, California 92024; Centre Hospitalier Universitaire de Limoges-Hôpital Dupuytren (A.J.), Limoges, France; Policlinico Universitario Campus Bio-Medico (G.T.), Rome, Italy; and Amgen Inc (W.Y., A.B., R.K.J.), Thousand Oaks, California 91320
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24
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Shalaby T, Anandappa S, Sivappriyan S, Kumar J. The Use of Denosumab in a Nonagenarian with Primary Hyperparathyroidism. EUROPEAN ENDOCRINOLOGY 2014; 10:151-152. [PMID: 29872480 PMCID: PMC5983085 DOI: 10.17925/ee.2014.10.02.151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 07/25/2014] [Indexed: 06/08/2023]
Abstract
Denosumab is a monoclonal antibody which is currently licensed in the UK drug market for the prevention of skeletal-related events secondary to malignancy (excluding myeloma). This monoclonal antibody is a 6 monthly subcutaneous injection that works by lowering calcium levels. When used in a 90 year old patient with primary hyperparathyroidism it demonstrated a dramatic reduction in the calcium level which had proven difficult to reduce by bisphosphonates and who was not a candidate for surgical intervention.
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Affiliation(s)
| | | | - Siva Sivappriyan
- Consultant Endocrinologist, Maidstone Hospital, Maidstone, Kent, UK
| | - Jesse Kumar
- Registrar in Acute Medicine and Endocrinology
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25
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Tsuda M, Ishiguro H, Yano I, Toi M. Re: Denosumab for patients with persistent or relapsed hypercalcemia of malignancy despite recent bisphosphonate treatment. J Natl Cancer Inst 2014; 106:dju137. [PMID: 24906398 DOI: 10.1093/jnci/dju137] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Moe Tsuda
- Affiliation of authors: Department of Breast Surgery (MTs, MTo) and Outpatient Oncology Unit (HI), Kyoto University Hospital, Kyoto, Japan; Graduate School of Pharmaceutical Sciences (IY), Kyoto University, Kyoto, Japan
| | - Hiroshi Ishiguro
- Affiliation of authors: Department of Breast Surgery (MTs, MTo) and Outpatient Oncology Unit (HI), Kyoto University Hospital, Kyoto, Japan; Graduate School of Pharmaceutical Sciences (IY), Kyoto University, Kyoto, Japan.
| | - Ikuko Yano
- Affiliation of authors: Department of Breast Surgery (MTs, MTo) and Outpatient Oncology Unit (HI), Kyoto University Hospital, Kyoto, Japan; Graduate School of Pharmaceutical Sciences (IY), Kyoto University, Kyoto, Japan
| | - Masakazu Toi
- Affiliation of authors: Department of Breast Surgery (MTs, MTo) and Outpatient Oncology Unit (HI), Kyoto University Hospital, Kyoto, Japan; Graduate School of Pharmaceutical Sciences (IY), Kyoto University, Kyoto, Japan
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26
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Adhikaree J, Newby Y, Sundar S. Denosumab should be the treatment of choice for bisphosphonate refractory hypercalcaemia of malignancy. BMJ Case Rep 2014; 2014:bcr-2013-202861. [PMID: 24481018 DOI: 10.1136/bcr-2013-202861] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Denosumab, a fully humanised monoclonal antibody, is licensed for treatment of postmenopausal osteoporosis, hormone ablation-induced bone loss and for prevention of skeleton-related events in patients with bone metastases from solid tumours. In pivotal phase 3 randomised trials, denosumab caused profound hypocalcaemia in patients with normocalcaemia despite oral calcium and vitamin D supplementation. This significant hypocalcaemic effect can be exploited to treat hypercalcaemia of malignancy (HCM). Recent reports from the USA suggest that denosumab is an effective treatment of HCM. According to our knowledge, we report the first two cases in UK with bisphosphonate refractory hypercalcaemia who responded to denosumab injections. Our first case gained 7 months of stabilisation of hypercalcaemia following prolonged admissions with life-threatening levels, while our second case achieved rapid normalisation of serum calcium levels for the first time in 14 months. We conclude that denosumab should be the treatment of choice for patients with bisphosphonate refractory hypercalcaemia.
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Affiliation(s)
- Jason Adhikaree
- Department of Oncology, Nottingham City Hospital, Nottingham, UK
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27
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Dietzek A, Connelly K, Cotugno M, Bartel S, McDonnell AM. Denosumab in hypercalcemia of malignancy: A case series. J Oncol Pharm Pract 2014; 21:143-7. [DOI: 10.1177/1078155213518361] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Denosumab is a nuclear factor-kappa ligand monoclonal antibody whose FDA-approved indications include treatment of osteoporosis, bone loss with certain anticancer hormonal agents, and prevention of skeletal-related events in patients with bone metastases from solid tumors. In clinical trials, the incidence of severe hypocalcemia has been reported as 3.1–10.8%. To date, case reports and two clinical trials have reported the use of denosumab in the management of hypercalcemia of malignancy. No reports of denosumab-induced hypocalcemia have been reported for the hypercalcemia of malignancy population. Methods We performed a retrospective chart review of all patients who received denosumab for hypercalcemia of malignancy to describe the effects of denosumab on calcium levels at our institution. Results Seven patients received doses of denosumab for hypercalcemia of malignancy. The most common tumor types were breast cancer (n = 3) and hematologic malignancies (n = 2). All patients had bone involvement. Two patients received single doses of 60 mg. The other five patients received 120 mg. The mean corrected calcium levels were 13.7 mg/dL and 12.24 mg/dL for the days of admission and denosumab administration, respectively (p = 0.1889). The mean corrected calcium level for the last known value was 9.92 mg/dL, while in house (p = 0.0016). Supportive care prior to denosumab included hydration (n = 7), bisphosphonates (n = 6), and calcitonin (n = 5). One patient had a calcium level of 6.6 mg/dL on day 4 after denosumab, requiring calcium supplementation and telemetry. Of the seven patients treated with denosumab for hypercalcemia of malignancy at our institution, six patients were discharged alive. Of these, one patient died two days after discharge. Last-known follow-up was a median of 26 days, range, 3–195, for all patients. Conclusions Denosumab helped decrease calcium in patients with hypercalcemia of malignancy. However, symptomatic hypocalcemia may result from denosumab in hypercalcemia of malignancy.
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Affiliation(s)
- Amanda Dietzek
- Division of Pharmacy, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Kelly Connelly
- Smilow Cancer Hospital at Yale New Haven, New Haven, CT, USA
| | - Michael Cotugno
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA
| | - Sylvia Bartel
- Division of Pharmacy, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA
| | - Anne M McDonnell
- Department of Pharmacy, Brigham and Women’s Hospital, Boston, MA, USA
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