Comparison of aminohydroxypropylidene diphosphonate, mithramycin, and corticosteroids/calcitonin in treatment of cancer-associated hypercalcaemia.
Thirty-nine patients with cancer-associated hypercalcaemia were randomly allocated to receive aminohydroxypropylidene diphosphonate (APD), mithramycin, or corticosteroids and salmon calcitonin. Corticosteroids/calcitonin had the fastest calcium-lowering effect, owing mainly to an acute reduction in renal tubular calcium reabsorption; continued therapy over 9 days failed to suppress accelerated bone resorption, however, and most patients remained hypercalcaemic. Mithramycin also substantially reduced serum calcium within 24 h. A further dose on day 2 generally controlled hypercalcaemia until day 6 by reducing both bone resorption and renal tubular calcium reabsorption. By day 9, however, about 50% of the mithramycin-treated patients had started to relapse as bone resorption increased again. With APD serum calcium levels fell more slowly but progressively owing to effective suppression of bone resorption; by day 9 the control of hypercalcaemia was significantly better than in the other treatment groups. Symptoms of hypercalcaemia were greatly relieved, especially by APD.
Ralston
S H
SH
Gardner
M D
MD
Dryburgh
F J
FJ
Jenkins
A S
AS
Cowan
R A
RA
Boyle
I T
IT
D002116:Calcitonin / Q000008:administration & dosage / Q000627:therapeutic use; D002118:Calcium / Q000097:blood / Q000652:urine; D002986:Clinical Trials as Topic; D003404:Creatinine / Q000097:blood; D004164:Diphosphonates / Q000627:therapeutic use* / Q000652:urine; D004359:Drug Therapy, Combination; D006801:Humans; D006934:Hypercalcemia / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000652:urine; D009369:Neoplasms / Q000097:blood / Q000150:complications*; D000077268:Pamidronate; D008926:Plicamycin / Q000627:therapeutic use*; D011239:Prednisolone / Q000008:administration & dosage* / Q000627:therapeutic use; D011897:Random Allocation
D004164:Diphosphonates; D002116:Calcitonin; D011239:Prednisolone; D003404:Creatinine; D008926:Plicamycin; D000077268:Pamidronate; D002118:Calcium