Identifying optimal magnesium replenishment points based on risk of severe hypomagnesemia in colorectal cancer patients treated with cetuximab or panitumumab

Kimura, Michio; Usami, Eiseki; Teramachi, Hitomi; Yoshimura, Tomoaki

doi:10.1007/s00280-020-04126-9

Cited by 5 publications

(4 citation statements)

References 24 publications

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“…For this CQ8, we searched for the literature, emphasizing suppression of hypomagnesemia exacerbation at hypomagnesemia onset during administration of anti-EGFR antibody drugs. There were no studies involving a control group, and finally, we extracted two case series studies and one SR [74][75][76].…”

Section: Targetmentioning

confidence: 99%

Clinical questions and good practice statements of clinical practice guidelines for management of kidney injury during anticancer drug therapy 2022

Yanagita,

Muto,

Nishiyama

et al. 2023

Clin Exp Nephrol

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Section: Targetmentioning

confidence: 99%

Clinical questions and good practice statements of clinical practice guidelines for management of kidney injury during anticancer drug therapy 2022

Yanagita,

Muto,

Nishiyama

et al. 2023

Clin Exp Nephrol

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“…Kimura et al have recommended initiating magnesium supplementation in patients with pre-replenishment levels of <1.8 mg/dL, preferably before reaching intra-treatment levels of <1.1 mg/dL, in order to mitigate the risk of severe hypomagnesemia while receiving anti-EGFR therapy. 20) Although the optimal timing of magnesium supplementation was not evaluated in the present study, early magnesium supplementation could facilitate the prevention of the deterioration of hypomagnesemia in patients receiving panitumumab, particularly in those with concomitant PPI use. Moreover, the necessity for PPIs should be reevaluated in patients receiving panitumumab with PPIs, and their serum magnesium levels should be monitored more vigilantly.…”

Section: Discussionmentioning

confidence: 90%

Risk Evaluation of Proton Pump Inhibitors for Panitumumab-Related Hypomagnesemia in Patients with Metastatic Colorectal Cancer

Katsura,

Suga,

Kubo

et al. 2024

Biological & Pharmaceutical Bulletin

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Hypomagnesemia commonly occurs as a side effect of panitumumab treatment. In severe cases, temporary discontinuation or dose reduction of panitumumab may be necessary. Proton pump inhibitors (PPIs) are reportedly potential risk factors for hypomagnesemia. We conducted a multicenter study to assess the impact of PPIs on the risk of grade 3-4 hypomagnesemia in patients with metastatic colorectal cancer (mCRC) receiving panitumumab. We adjusted for potential bias using a propensity score-matched analysis and retrospectively reviewed the medical records of patients. Hypomagnesemia severity was graded according to the Common Terminology Criteria for Adverse Events, version 5.0. A total of 165 patients were enrolled in this study. The incidence of grade 3-4 hypomagnesemia was significantly higher in the PPI group than in the non-PPI group, both before (20.0% [30/60] vs. 8.0% [8/105], p 0.026) and after propensity score matching (16.2% [6/37] vs. 0% [0/37], p 0.025). In the propensity score-matched cohort, the risk of grade 3-4 hypomagnesemia was significantly higher in the PPI group (odds ratio, 2.19; 95% confidence interval, 1.69-2.84; p 0.025). These findings suggest that concomitant use of PPIs significantly increases the risk of grade 3-4 hypomagnesemia in patients with mCRC receiving panitumumab. Therefore, close monitoring of these patients is imperative.

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“…The goal of oral MG replacement should be to prevent further decline in MG as opposed to significant increases in MG levels. A recent retrospective study from Japan also suggests initiation of early MG supplementation if baseline levels are low prior to EGFRI therapy 23 …”

Section: Discussionmentioning

confidence: 99%

“…A recent retrospective study from Japan also suggests initiation of early MG supplementation if baseline levels are low prior to EGFRI therapy. 23 While it is recognized that severe hypomagnesemia has been associated with cardiac arrhythmia, 6 a knowledge user survey of 40 Canadian gastrointestinal medical oncologists regarding EGFRIinduced hMg management showed that 97.5% of respondents do not assess electrocardiograms (ECGs) in patients who develop hMg despite the potential for serious cardiac complications. 11 In the current study, 3 (20%) patients (all male) had a baseline QTcF of >450 ms impaired PTH release and function.…”

Section: Discussionmentioning

confidence: 99%

Oral magnesium supplements for cancer treatment‐induced hypomagnesemia: Results from a pilot randomized trial

Awan

Basulaiman

Stober

et al. 2021

Health Science Reports

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Background and Aims Optimal management of cancer treatment‐induced hypomagnesemia (hMg) is not known. We assessed the feasibility of using a novel pragmatic clinical trials model to compare two commonly used oral Mg replacement strategies. Methods Patients with grade 1 to 3 hMg while receiving either platinum‐based chemotherapy or epidermal growth factor receptor inhibitors (EGFRI) were randomized to oral magnesium oxide (MgOx) or oral magnesium citrate (MgCit). The trial methodology utilized the integrated consent model. Feasibility would be successful if; accrual rate was ≥5 patients a month and if measures of patient and physician engagement, were > 50%. Secondary endpoints included; comparison of Mg levels, cardiac arrhythmias, and rates of treatment delay/hospitalizations. Results From July 2016 to December 2017, an average of 1 patient a month was accrued. All 15 eligible and approached patients consented to participate in the study (100% engagement) and 7/15 were randomized to MgOx and 8/15 to MgCit. The percentage of physicians who approached patients for the study was 4 of 6 (66.6% engagement). The mean slope of change in Mg (mmol/L/day) was 0.0022 (95% CI: −0.0001 to 0.0044) for MgOx and 0.0006 (95% CI, −0.0012 to 0.0024) for MgCit (P = .2123). Three patients (20%) required IV magnesium while on the study (2 MgCit and 1 MgOx). Grade 1 diarrhea occurred in 3 patients in the MgCit arm. Conclusion Despite oral magnesium tolerability and meeting most of its feasibility endpoints, this study did not meet its target accrual rate. Alternative designs would be necessary for a definitive efficacy study.

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Identifying optimal magnesium replenishment points based on risk of severe hypomagnesemia in colorectal cancer patients treated with cetuximab or panitumumab

Cited by 5 publications

References 24 publications

Clinical questions and good practice statements of clinical practice guidelines for management of kidney injury during anticancer drug therapy 2022

Clinical questions and good practice statements of clinical practice guidelines for management of kidney injury during anticancer drug therapy 2022

Risk Evaluation of Proton Pump Inhibitors for Panitumumab-Related Hypomagnesemia in Patients with Metastatic Colorectal Cancer

Oral magnesium supplements for cancer treatment‐induced hypomagnesemia: Results from a pilot randomized trial

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