Gallium nitrate for acute treatment of cancer-related hypercalcemia. A randomized, double-blind comparison to calcitonin.
OBJECTIVE
To determine whether gallium nitrate therapy is superior to maximally approved doses of calcitonin for acute control of cancer-related hypercalcemia.


METHODS
Randomized, double-blind comparison of active treatments.


METHODS
Comprehensive cancer center.


METHODS
One hundred ninety-eight consecutive hypercalcemic events in 164 patients screened for entry.


METHODS
hospitalization and intravenous hydration for at least 2 days; persistent elevated serum calcium levels of 2.99 mmol/L or greater (adjusted for serum albumin); serum creatinine levels of 221 mumol/L or less; no cytotoxic chemotherapy, radiation, or mithramycin within the preceding 7 days or during study; no concurrent use of aminoglycoside antibiotics; life expectancy greater than 4 weeks; lymphoma and parathyroid carcinoma excluded. Patients were stratified by histologic type of tumor (epidermoid or nonepidermoid). Fifty patients were randomized and treated.


METHODS
Gallium nitrate 200 mg/m2 body surface area for 5 days by continuous intravenous infusion, or salmon calcitonin 8 IU/kg body weight every 6 hours for 5 days by intramuscular injection. Patients randomized to receive gallium nitrate received sham injections of saline to simulate calcitonin; patients randomized to receive calcitonin received 1000 mL 5%-dextrose solution to simulate gallium nitrate.


RESULTS
All patients were evaluable. Eighteen of twenty-four patients who received gallium nitrate achieved normocalcemia compared with 8 of 26 patients who received calcitonin for an observed difference of 44% (95% confidence interval, 19% to 69%; P = 0.002). Median duration of normocalcemia before other cytotoxic or hypocalcemic therapy was 6 days for patients treated with gallium nitrate compared with 1 day for patients treated with calcitonin (P less than 0.001). Median duration of normocalcemia regardless of intercurrent treatment and without adjustment for serum albumin was 11+ days for patients treated with gallium nitrate and 2 days for patients treated with calcitonin (P less than 0.01). Mean daily fluid intake and mean daily dose of furosemide were similar in both treatment groups. No additional benefit was seen in 9 patients randomized to receive calcitonin who incidentally received corticosteroids.


CONCLUSIONS
Gallium nitrate therapy is highly effective and superior to maximally approved doses of calcitonin for acute control of cancer-related hypercalcemia.
Warrell
R P
RP
Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, New York.
Israel
R
R
Frisone
M
M
Snyder
T
T
Gaynor
J J
JJ
Bockman
R S
RS
D000328:Adult; D000368:Aged; D002116:Calcitonin / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D005440:Fluid Therapy; D005665:Furosemide / Q000008:administration & dosage; D005708:Gallium / Q000009:adverse effects / Q000627:therapeutic use*; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006934:Hypercalcemia / Q000188:drug therapy* / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010257:Paraneoplastic Syndromes / Q000188:drug therapy*; D011897:Random Allocation
D005938:Glucocorticoids; D005665:Furosemide; D002116:Calcitonin; D005708:Gallium; C027235:gallium nitrate