Phosphate Disorders in Cancer

Phosphate disorders are common in patients with cancer. Hypophosphatemia and hyperphosphatemia, both, can lead to significant morbidity, and their mechanisms are uniquely influenced by tumor biology, anti-cancer therapies, and cellular shifts. Malignancies that can influence phosphate include MM that can cause both hypo- and hyperphosphatemia. Tumor-induced osteomalacia can lead to hypophosphatemia as well. Drug-induced renal phosphate wasting is a contributor to hypophosphatemia often associated with platinum-based therapy and tyrosine kinase inhibitors. Conversely, hyperphosphatemia often results from tumor lysis syndrome and can manifest as symptomatic hypocalcemia and acute kidney injury. A step wise approach in determining the mechanism of hypophosphatemia and hyperphosphatemia is crucial to identify most appropriate treatment, especially with the expanding use of novel cancer therapies. This review summarizes the key mechanisms and management of phosphate disorders in oncology care in the current era.