Severe Hypocalcemia due to Denosumab in Metastatic Prostate Cancer

Adnan, Mohammed; Bhutta, Usman; Iqbal, Tanzeel; AbdulMujeeb, Sufyan; Haragsim, Lukas; Amer, Syed

doi:10.1155/2014/565393

Cited by 17 publications

(9 citation statements)

References 3 publications

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“…A patient with low levels of vitamin D has a higher chance of getting hypocalcemia after denosumab. Level of calcium, phosphorus and vitamin D level should be checked and replaced before starting the therapy [1]. In the case of our patient, calcium level was one month old and vitamin levels were never checked before initiation of therapy, which might be the cause of her severely decreased calcium level.…”

Section: Juniper Online Journal Of Case Studiesmentioning

confidence: 86%

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Case Report: Denosumab Induced Hypocalcemia Refractory to Calcium Supplementation

Regmi

2018

JOJCS

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A 70 years old female with PMH of CAD, Hyperlipidemia and recently diagnosed poorly differentiated carcinoma of unknown primary with diffuse bone metastases presented to the ED with hypotension, diaphoresis and tachycardia. Nine days before presenting to the ED she was started on Nivolumab and Denosumab. She was initially admitted with sepsis but later no source of infection was found, and antibiotics were stopped on day three. On the day of admission her calcium was 7.3mg/dl, whereas one month back it was in the normal range, which further decreased to 5.8mg/dl on 3rd day of admission. Because of her worsening hypocalcemia her Vitamin D, phosphorus and PTH level was also checked. It was noted that Vit D and phosphorus were decreased and PTH was increased. Despite the calcium gluconate her calcium level were not increasing. Nephrology was consulted and was started on calcitriol and ergocalciferol. Subsequently her calcium level started to rise and went up to 7.3, four days after initiation of therapy.

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Section: Juniper Online Journal Of Case Studiesmentioning

confidence: 86%

“…It is used for the prevention of skeletal-related events in patients with bone metastases from solid tumors. The recommended dose is 120mg subcutaneously every four weeks [1].…”

Section: Discussionmentioning

confidence: 99%

Case Report: Denosumab Induced Hypocalcemia Refractory to Calcium Supplementation

Regmi

2018

JOJCS

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“…Hypocalcaemia in patients with cancer frequently relates to a poor nutritional status, and these individuals often have low albumin and/or vitamin D concentrations [ 24 ]; therefore, as discussed above, it is important to correct serum calcium measurements for albumin levels. Moreover, vitamin D deficiency is associated with an increased risk of hypocalcaemia following treatment with inhibitors of bone resorption [ 33 , 34 ] and is common in elderly people and those with cancer [ 35 , 36 ]. Hence, vitamin D deficiency is a concern in men with prostate cancer, given that their median age at diagnosis is 66 years [ 37 ].…”

Section: Main Textmentioning

confidence: 99%

Hypocalcaemia in patients with prostate cancer treated with a bisphosphonate or denosumab: prevention supports treatment completion

et al. 2018

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BackgroundMost patients with advanced prostate cancer develop bone metastases, which often result in painful and debilitating skeletal-related events. Inhibitors of bone resorption, such as bisphosphonates and denosumab, can each reduce the incidence of skeletal-related events and delay the progression of bone pain. However, these agents are associated with an increased risk of hypocalcaemia, which, although often mild and transient, can be serious and life-threatening. Here we provide practical advice on managing the risk of hypocalcaemia in patients with advanced prostate cancer who are receiving treatment with bone resorption inhibitors. Relevant references for this review were identified through searches of PubMed with the search terms ‘prostate cancer’, ‘bone-targeted agents’, ‘anti-resorptive agents’, ‘bisphosphonates’, ‘zoledronic acid’, ‘denosumab’, ‘hypocalcaemia’, and ‘hypocalcemia’. Additional references were suggested by the authors.Main textAmong patients with advanced cancer receiving a bisphosphonate or denosumab, hypocalcaemia occurs most frequently in those with prostate cancer, although it can occur in patients with any tumour type. Consistent with its greater ability to inhibit bone resorption, denosumab has shown superiority in the prevention of skeletal-related events in patients with bone metastases from solid tumours. Consequently, denosumab is more likely to induce hypocalcaemia than the bisphosphonates. Likewise, various bisphosphonates have differing potencies for the inhibition of bone resorption, and thus the risk of hypocalcaemia varies between different bisphosphonates. Other risk factors for the development of hypocalcaemia include the presence of osteoblastic metastases, vitamin D deficiency, and renal insufficiency. Hypocalcaemia can lead to treatment interruption, but it is both preventable and manageable. Serum calcium concentrations should be measured, and any pre-existing hypocalcaemia should be corrected, before starting treatment with inhibitors of bone resorption. Once treatment has started, concomitant administration of calcium and vitamin D supplements is essential. Calcium concentrations should be monitored during treatment with bisphosphonates or denosumab, particularly in patients at high risk of hypocalcaemia. If hypocalcaemia is diagnosed, patients should receive treatment with calcium and vitamin D.ConclusionWith preventative strategies and treatment, patients with prostate cancer who are at risk of, or who develop, hypocalcaemia should be able to continue to benefit from treatment with bisphosphonates or denosumab.

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“…Hypocalcemia is a known adverse effect of denosumab. Life-threatening and fatal cases have been reported with concomitant renal impairment (6)(7)(8). We report a case of recurrent, prolonged, denosumab-induced hypocalcemia following a single denosumab dose in a man diagnosed with metastatic prostate cancer and acute kidney injury (AKI) whose initial hypocalcemia episode resolved but recurred without additional denosumab and took 111 days to resolve.…”

Section: Introductionmentioning

confidence: 99%

Severe, Prolonged, Denosumab-Induced Hypocalcemia With Recovery After 111 Days Of High-Dose Calcium Supplementation

McCaleb¹,

Johnson²

2019

AACE Clinical Case Reports

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Objective: Denosumab is a monoclonal antibody commonly used for the prevention of skeletal-related events in patients with bone metastases from solid tumors. Hypocalcemia is a known adverse effect with denosumab, and we present an unusual case where 2 hypocalcemic events occurred after 1 denosumab treatment.Methods: A 76-year-old man recently diagnosed with prostate cancer with bone metastasis was given 120 mg denosumab subcutaneously due to extensive bone disease.Results: The patient experienced denosumab-induced hypocalcemia induced by a single denosumab dose which was resolved after 14 days of multiple doses of intravenous calcium gluconate and oral calcium and vitamin D replacement. However, the patient returned with acute kidney injury and severe hypocalcemia (corrected calcium of 6.9 mg/dL) without any additional dose of denosumab. The recovery following the second episode of hypocalcemia was much longer than the initial episode in this patient.Conclusion: To our knowledge, this is the first reported case of an additional episode of hypocalcemia following a single denosumab dose. This case highlights the importance of close monitoring of renal function and serum electrolytes following the resolution of denosumab-induced hypocalcemia. (AACE Clinical Case Rep. 2019;5: e82-e85) Abbreviations: 25(OH)D = 25-hydroxyvitamin D; AKI = acute kidney injury; CI = confidence interval; IV = intravenous; PTH = parathyroid hormone; SRE = skeletal-related event; ZA = zoledronic acid

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Severe Hypocalcemia due to Denosumab in Metastatic Prostate Cancer

Cited by 17 publications

References 3 publications

Case Report: Denosumab Induced Hypocalcemia Refractory to Calcium Supplementation

Case Report: Denosumab Induced Hypocalcemia Refractory to Calcium Supplementation

Hypocalcaemia in patients with prostate cancer treated with a bisphosphonate or denosumab: prevention supports treatment completion

Severe, Prolonged, Denosumab-Induced Hypocalcemia With Recovery After 111 Days Of High-Dose Calcium Supplementation

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