3(Amino-1,1-hydroxypropylidene) bisphosphonate (APD) for hypercalcaemia of breast cancer

The effect of a single dose of APD on hypercalcaemia has been studied in advanced breast cancer. Twenty-five patients were rehydrated intravenously for 48 h. Twenty-three remained hypercalcaemic and received 5-15 mg APD as a 2 h infusion. Eighteen patients achieved normocalcaemia, 15 after a dose of less than or equal to 15 mg. One patient died within 24 h from rapidly advancing disease and 4 remained hypercalcaemic. Urinary calcium excretion increased during rehydration as glomerular function improved and tubular reabsorption of calcium fell. After APD, calcium excretion fell to normal in 22/24 patients reflecting inhibition of bone resorption. Hydroxyproline excretion remained high. The effect of a single dose of APD on hypercalcaemia lasted a median of 11 days (range 7-17). Transient fever occurred in 2 patients, but there were no other side effects. The possibility of long-term control of osteolysis using a 2 weekly schedule of APD administration is now being studied.