Hypercalcemia of malignancy (HCM) is the most common metabolic complication observed in cancer patients and is associated with a high degree of morbidity and mortality. It is estimated to affect 2% to 30% of patients and is observed more frequently in patients with breast, lung and kidney cancer, as well as multiple myeloma.
The Endocrine Society has now created the first framework for the treatment of HCM.
The guidelines were published online on Journal of Clinical Endocrinology & Metabolism and will appear in the March 2023 print edition.
«Our guidelines have followed a rigorous procedure to review the evidence available so far and offer a clinical care workflow based on the severity and pathophysiology of malignant hypercalcemia, taking into account contextual factors,» says Dr. Wang.Ghada El-Hajj Fuleihan, MPH, of the American University of Beirut, Beirut, Lebanon, and chair of the committee that drafted the guidelines.
He adds that healthcare professionals currently have few evidence-based recommendations regarding which medications to use to treat this condition.
The introduction of more effective chemotherapeutic agents helped reduce mortality rates from HCM, as well as its incidence, it explains in a statement. «In addition to the best antineoplastic treatments, we can treat HCM with drugs aimed at slowing bone resorption (breakdown) and the release of calcium into the blood,» he adds.
A multidisciplinary panel of experts
The new guidelines were drafted by a multidisciplinary panel of clinical experts. Recommendations include the following:
- Treatment with intravenous bisphosphonates or denosumab is recommended compared to management without these agents.
- Treatment with denosumab rather than intravenous bisphosphonates is suggested.
- In adults with severe HCM, defined as serum calcium>14 mg/dl (3.5 mmol/l), a combination of calcitonin and an intravenous bisphosphonate or denosumab is suggested as initial treatment compared to only an intravenous bisphosphonate or denosumab.Due to tachyphylaxis, calcitonin treatment should be limited to 48–72 hours.
- Denosumab is suggested for patients with refractory/recurrent HCM receiving intravenous bisphosphonate.
- For HCM caused by tumours associated with high calcitriol levels, such as lymphomas, and in adults already on glucocorticoid therapy but continuing to present with severe or symptomatic hypercalcaemia, the addition of intravenous bisphosphonate or denosumab is suggested.
- In cases of HCM due to parathyroid cancer, the panel suggests treatment with a calcimimetic or intravenous bisphosphonate or denosumab; In addition to
- Evaluate surgical treatment, if feasible, once control of severe hypercalcemia has been achieved.
- Depending on the clinical situation and the severity of hypercalcemia, intravenous bisphosphonate or denosumab is useful before the start of calcimimetic.For patients with mild hypercalcemia and related symptoms, initiation of calcimimetic therapy is suggested. However, in the case of individuals with moderate to severe hypercalcemia and related symptoms, initial therapy should be a bisphosphonate or denosumab.
- In patients with hypercalcemia due to parathyroid carcinoma inadequately controlled despite treatment with a calcimimetic, the addition of intravenous bisphosphonate or denosumab is suggested.
- For patients with hypercalcemia due to parathyroid carcinoma inadequately controlled with an intravenous bisphosphonate or denosumab, the panel suggests the addition of a calcimimetic.
- Evaluate surgical treatment, if feasible, once control of severe hypercalcemia has been achieved.
- Depending on the clinical situation and the severity of hypercalcemia, intravenous bisphosphonate or denosumab is useful before the start of calcimimetic.For patients with mild hypercalcemia and related symptoms, initiation of calcimimetic therapy is suggested. However, in the case of individuals with moderate to severe hypercalcemia and related symptoms, initial therapy should be a bisphosphonate or denosumab.
«The recommendations provide a framework for the medical management of adults with HCM and include important decision-making and contextual factors,» the committee concludes. «The guidelines underscore current gaps in our knowledge that can be used to establish future research plans.»
The article is an adaptation of the original, written by Roxanne Nelson, which appeared on Medscape.com, part of Medscape Professional Network.
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Source — https://www.univadis.it/viewarticle/linee-guida-per-la-gestione-dellipercalcemia-correlata-al-cancro