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Burosumab in tumor-induced osteomalacia: A case report
Alvin Lee Day1, Orlando M Gutiérrez2, Barton L Guthrie3
1Division of Clinical Immunology and Rheumatology, Department of Medicine, University of Alabama at Birmingham, 1720 2nd Avenue South, FOT 839, 35294 Birmingham, AL, USA.
Joint Bone Spine
|August 6, 2019
Summary
Tumor-induced osteomalacia, a rare condition causing low phosphate, can be treated with burosumab when surgery isn't an option. This fibroblast growth factor-23 inhibitor improved patient mobility and normalized phosphate levels.
Area of Science:
- Endocrinology
- Oncology
- Nephrology
Background:
- Tumor-induced osteomalacia (TIO) is a rare paraneoplastic syndrome characterized by hypophosphatemia due to excessive fibroblast growth factor-23 (FGF23) production.
- Surgical resection of the causative tumor is the primary curative treatment for TIO.
- Medical management is considered when tumors are unresectable, unidentified, or surgery is declined.
Observation:
- A patient presented with severe bone pain, fractures, and wheelchair dependence due to TIO.
- Diagnostic workup revealed two intracranial meningiomas, precluding surgical intervention.
- Medical treatment was chosen due to surgical contraindications and potential radiosurgery limitations.
Findings:
- Burosumab, a monoclonal antibody targeting FGF23, was administered to the patient.
- Treatment resulted in significant improvement in bone pain and patient mobility.
- Serum phosphate levels normalized following burosumab initiation.
Implications:
- This case highlights burosumab as a potential medical treatment for TIO when surgical options are not feasible.
- Further clinical trials are warranted to establish burosumab's efficacy and safety in TIO management.
- Burosumab offers a promising therapeutic avenue for patients with unresectable or surgically challenging TIO.
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