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Treatment of malignant hypercalcaemia
1Bone and Mineral Research Laboratory, Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain.
Expert Opinion on Pharmacotherapy
|May 9, 2002
Summary
Hypercalcaemia of malignancy (HM) is often treated with bisphosphonates, which inhibit bone resorption. For humoral HM, gallium nitrate is preferred, while new therapies targeting calcium reabsorption are under development.
Area of Science:
- Oncology
- Endocrinology
- Pharmacology
Background:
- Hypercalcaemia is a frequent paraneoplastic syndrome in cancer patients.
- It results from tumor-produced factors influencing bone resorption and calcium reabsorption.
- Current treatments include hydration and drugs inhibiting bone resorption.
Purpose of the Study:
- To review current and future therapeutic strategies for hypercalcaemia of malignancy (HM).
- To compare the efficacy of different antihypercalcaemic agents.
- To identify optimal treatments for specific types of HM, including humoral HM (HHM).
Main Methods:
- Review of existing literature on antihypercalcaemic therapies.
- Comparison of drug classes: plicamycin, calcitonin, bisphosphonates, and gallium nitrate.
- Evaluation of efficacy and toxicity profiles of standard and emerging treatments.
Main Results:
- Bisphosphonates are standard therapy for HM, with pamidronate and zoledronate showing high efficacy (>90% normalization of serum calcium).
- Gallium nitrate is recommended for humoral HM due to its effect on tubular calcium reabsorption.
- Calcitonin has limited effectiveness but may help severe symptomatic cases initially.
Conclusions:
- Bisphosphonates, particularly zoledronate, are effective for HM, but do not address tubular calcium reabsorption.
- Gallium nitrate is a key option for HHM.
- Future treatments may involve novel bone resorption inhibitors or agents targeting parathyroid hormone-related protein and calcium reabsorption.