Management of hypercalcemia in breast cancer

Hypercalcemia is a common metabolic problem in patients with metastatic breast cancer. Osteolytic bone destruction with release of calcium into circulation and humoral factors can lead to hypercalcemia. Clinical manifestations may be so mild as to be overlooked or include severe nervous system, gastrointestinal and renovascular complications. Treatment with saline infusions to replenish intravascular volume and restore renal function provides the basis for other therapeutic interventions. A variety of pharmacologic approaches include intravenous fluids, diuretics, steroids, calcitonin, bisphosphonates, and plicamycin. Investigation of new agents, particularly bisphosphonates and gallium, continues. The optimal treatment of hypercalcemia in breast cancer patients has not been defined, though control of metastatic disease obviously is of utmost importance.