A RANKL Wrinkle: Denosumab-Induced Hypocalcemia
| Autor: | Silas W. Smith, Danny M. Lugassy, Larissa K. Laskowski, Kelly Kavcsak, David S. Goldfarb, Mary Ann Howland |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Bone disease Health Toxicology and Mutagenesis Osteoporosis chemistry.chemical_element Bone Neoplasms 030209 endocrinology & metabolism Calcium Toxicology Bone resorption 03 medical and health sciences 0302 clinical medicine Internal medicine Antineoplastic Combined Chemotherapy Protocols medicine Humans Etoposide Chvostek sign Aged Bone Density Conservation Agents Hypocalcemia biology business.industry RANK Ligand Prostatic Neoplasms Neoplasms Second Primary medicine.disease Combined Modality Therapy Small Cell Lung Carcinoma Neoplasm Proteins Treatment Outcome Endocrinology Denosumab chemistry RANKL 030220 oncology & carcinogenesis biology.protein Toxicology Observation medicine.symptom business medicine.drug |
| Zdroj: | Journal of Medical Toxicology. 12:305-308 |
| ISSN: | 1937-6995 1556-9039 |
| DOI: | 10.1007/s13181-016-0543-y |
| Popis: | The human monoclonal antibody denosumab inhibits osteoclast-mediated bone resorption by binding to receptor activator of nuclear factor κB ligand (RANKL), which is upregulated by tumor cells. Denosumab is indicated to prevent skeletal-related events (SREs) from osteoporosis and metastatic bone disease. We report a case of denosumab-induced hypocalcemia to highlight potential toxicity and treatment considerations. A 66-year-old man with prostate cancer, small cell lung cancer, and bone metastases presented with fatigue, weakness, and muscle spasm. Sixteen days prior, he received cycle 6 of cisplatin and etoposide, leuprolide, and denosumab (120 mg subcutaneously). His examination demonstrated a slight resting tremor, normal strength, and negative Chvostek sign. Laboratory analysis revealed hemoglobin, 8.0 g/dL; total calcium, 5.2 mg/dL (pre-denosumab, 8.9 mg/dL); and magnesium, 0.7 mg/dL. He initially received two units packed red blood cells, intravenous calcium and magnesium, and vitamin D. During his hospitalization, he required multiple doses of intravenous and oral calcium, magnesium, and vitamin D. Despite ongoing oral supplementation, his post-discharge serum calcium fluctuated significantly, requiring close monitoring and frequent dose adjustments. Denosumab’s unique antiresorptive properties yield fewer SREs. The trade-off is increased hypocalcemia risk, which may be severe and require aggressive, prolonged supplementation and monitoring. |
| Databáze: | OpenAIRE |
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