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Supportive Care in Cancer

, Volume 25, Issue 5, pp 1639–1649

First Online: 12 January 2017Received: 19 August 2016Accepted: 12 December 2016DOI: 10.1007-s00520-016-3543-1

Cite this article as: Body, JJ., Niepel, D. & Tonini, G. Support Care Cancer 2017 25: 1639. doi:10.1007-s00520-016-3543-1

Abstract

Calcium metabolism in cancer and hypercalcaemia of malignancyThe balance between bone formation and resorption may be disrupted in patients with cancer, leading either to increased bone resorption, calcium release, and possibly hypercalcaemia, or to increased bone formation, sequestration of calcium, and possibly hypocalcaemia. In adults, hypercalcaemia of malignancy is most common in patients with tumours that produce factors that induce osteoclast activation and enhance bone resorption. Impaired renal function and increased renal tubular calcium resorption may further affect calcium levels.

Treatment of hypercalcaemia of malignancyInhibitors of bone resorption, first the bisphosphonates and, later, denosumab, have been shown to be effective in hypercalcaemia treatment. Bisphosphonates which are administered intravenously are approved for hypercalcaemia of malignancy and are the current mainstay of treatment, whereas denosumab which is administered subcutaneously may offer an option for patients who do not respond to bisphosphonates or suffer from renal insufficiency.

Hypocalcaemia: treatment and preventionHypocalcaemia is most common in patients with prostate cancer and osteoblastic bone metastases, but can occur in patients with a variety of tumour types who are receiving inhibitors of bone resorption. While patients often respond to calcium and vitamin D supplementation, prevention should be the aim; at-risk patients should be identified before starting treatment with inhibitors of bone resorption, be closely monitored during at least the first few months of treatment, and receive concomitant calcium and vitamin D supplementation unless hypercalcaemia is present.

ConclusionBoth hypercalcaemia and hypocalcaemia can be serious if left untreated. It is therefore important that patients with cancer are closely monitored and receive adequate prevention and treatment measures to maintain normal blood calcium levels.

KeywordsHypercalcaemia Hypocalcaemia Hypercalcaemia of malignancy Denosumab Bisphosphonates Highlights

• Disruption of bone turnover in cancer can lead to hypercalcaemia or hypocalcaemia

• Both conditions can be serious if left untreated

• Agents that inhibit bone resorption are effective treatments for hypercalcaemia

• Bone resorption inhibitors can cause or aggravate hypocalcaemia

• Physicians need to monitor calcium levels when treating patients with cancer





Author: Jean-Jacques Body - Daniela Niepel - Giuseppe Tonini

Source: https://link.springer.com/







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