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Ann Pharmacother. 2014 Sep;48(9):1159-1165. Epub 2014 Jun 13.

Time Course of Calcium Concentrations and Risk Factors for Hypocalcemia in Patients Receiving Denosumab for the Treatment of Bone Metastases From Cancer.

Author information

1
Department of Pharmacy, Kyushu University Hospital, Fukuoka, Japan ikesue@pharm.med.kyushu-u.ac.jp.
2
Department of Pharmacy, Kyushu University Hospital, Fukuoka, Japan.
3
Department of Medicine and Biosystemic Science, Graduate School of Medical Sciences, Kyushu University.
4
Department of Comprehensive Clinical Oncology, Faculty of Medical Sciences, Kyushu University.
5
Research Institute for Diseases of the Chest, Graduate School of Medical Sciences, Kyushu University.
6
Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University.
7
Department of Urology, Graduate School of Medical Sciences, Kyushu University.
8
Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University.

Abstract

BACKGROUND:

Severe hypocalcemia sometimes develops during denosumab treatment for bone metastases from cancer and is, therefore, an important issue. However, limited information is available on the risk factors for hypocalcemia and the appropriate interval for monitoring serum calcium concentration.

OBJECTIVE:

The present study aimed to identify the risk factors for grade ≥2 hypocalcemia and to investigate the time course of serum calcium concentrations in patients receiving denosumab for bone metastases from cancer.

METHOD:

The medical records of 66 cancer patients treated with denosumab between April 2012 and August 2013 were retrospectively reviewed.

RESULT:

Of the 66 enrolled patients, 11, 5, and 1 developed grade 1, 2, and 3 hypocalcemia, respectively. All 4 patients with a baseline estimated glomerular filtration rate (eGFR) of <30 mL/min developed hypocalcemia. Hypocalcemia occurred in only 20%, 24%, and 15% of patients with an eGFR of 30 to 59, 60 to 89, and ≥90 mL/min, respectively. Multivariate logistic regression analysis revealed that lower eGFR values (odds ratio, 1.72 per 10 mL/min decrease, P = 0.02) were significantly associated with grade ≥2 hypocalcemia. In 11 patients who developed hypocalcemia during the first treatment course, the mean calcium concentrations decreased from 9.8 mg/dL at baseline to 8.4 mg/dL during the first week and reached a nadir of 8.1 mg/dL during the second week.

CONCLUSION:

Our results support more frequent monitoring of serum calcium concentrations at baseline and during the first 2 weeks of treatment in patients receiving denosumab, especially those with an eGFR <30 mL/min.

KEYWORDS:

denosumab; glomerular filtration rate; hypocalcemia; kidney dysfunction; risk factor

PMID:
24928100
DOI:
10.1177/1060028014539919
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