High serum ALP level is associated with increased risk of denosumab-related hypocalcemia in patients with bone metastases from solid tumors

Endocrine Journal

Nobuaki Ito³  Yuichi Takashi²  Yuka Kinoshita³  Yusuke Shinoda¹  Seiji Fukumoto²  Masaomi Nangaku³  Makoto Arai³  Noriko Makita³ 

[1] Department of Rehabilitation Medicine, the University of Tokyo Hospital, Tokyo, Japan;Fujii Memorial Institute of Medical Sciences, Tokushima University, Tokushima, Japan;Division of Nephrology & Endocrinology, Department of Medicine, the University of Tokyo Hospital, Tokyo, Japan

关键词: Hypocalcemia;    Denosumab;    Alkaline phosphatase;    Performance status;   

DOI  :  10.1507/endocrj.EJ16-0003

学科分类：内分泌与代谢学

来源: Japan Endocrine Society

【 摘 要 】

References(21)Metastatic bone disease is one of the most common complications of advanced cancers.Pathological fractures, spinal cord compression, and radiotherapy or surgery to the bone are collectively called skeletal-related events (SREs), which cause severe pain, increase hospitalization rates, and impair the quality of life (QOL) of patients with bone metastases.The receptor activator of nuclear factor-kB ligand (RANKL)/RANK pathway is critical in the progression of bone metastases.Previous studies have demonstrated that an anti-RANKL antibody (denosumab) was superior to zoledronic acid in prolonging time to first SRE in patients with bone metastases from prostate and breast cancers.However, severe hypocalcemic events occur more frequently after treatment with denosumab compared with zoledronic acid.In this study, 368 administrations of denosumab in 219 patients with metastatic bone disease from solid tumors were analyzed to clarify the risk factors for developing hypocalcemia.The results showed that grade 2/3 hypocalcemia was observed in 10.4% of the total number of denosumab administrations.Patients with higher baseline serum ALP, higher performance status (PS), or gastric cancer were at higher risk for developing hypocalcemia.The cut-off value for ALP to predict denosumab-related hypocalcemia was 587 U/L with a sensitivity of 0.77 and a specificity of 0.81.Close monitoring of serum calcium, especially after the first treatment with denosumab, is strongly recommended in these patients.

【 授权许可】

Unknown