Acute management of cancer-related hypercalcemia.
OBJECTIVE
To review the pathogenesis and pharmacologic treatment of acute hypercalcemia associated with malignancy.


METHODS
A MEDLINE search (1966 to 1995) of the English-language literature pertaining to acute hypercalcemia was performed. Additional literature was obtained from reference lists of articles identified through the search.


METHODS
All articles discussing the etiology and medical management of cancer-related acute hypercalcemia were considered in this review. Clinical trials reporting efficacy and safety of antihypercalcemic agents were also included. Information selected in the review was based on the discretion of the authors.


RESULTS
Hypercalcemia is a life-threatening disorder associated with malignancy. It occurs in approximately 10-20% of patients with cancer. A variety of medications have been used in the management of hypercalcemia including bisphosphonates, calcitonin, furosemide, gallium nitrate, glucocorticoids, NaCl 0.9%, and plicamycin. Each of these agents has been reviewed with consideration of pharmacologic mechanism of action, evaluation of clinical trials, recommended dosages, efficacy, safety, cost, and role in treating cancer-related acute hypercalcemia.


CONCLUSIONS
Immediate management of cancer-related acute hypercalcemia to prevent death and provide symptomatic relief is warranted. Severity determined by symptoms, calcium concentrations, and the overall status of the patient are important considerations in selecting appropriate therapy. Although the specific role of individual agents may vary, hydration remains the cornerstone of therapy. NaCl 0.9%, calcitonin, and pamidronate disodium have established roles as dominant first-line agents for the management of acute hypercalcemia associated with malignancy.
Chisholm
M A
MA
Department of Pharmacy Practice, College of Pharmacy, University of Georgia, Athens, USA.
Mulloy
A L
AL
Taylor
A T
AT
D002116:Calcitonin / Q000009:adverse effects / Q000627:therapeutic use; D004164:Diphosphonates / Q000009:adverse effects / Q000627:therapeutic use; D005440:Fluid Therapy; D005708:Gallium / Q000627:therapeutic use; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D006934:Hypercalcemia / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy*; D009369:Neoplasms / Q000150:complications*; D008926:Plicamycin / Q000627:therapeutic use
D004164:Diphosphonates; D005938:Glucocorticoids; D002116:Calcitonin; D005708:Gallium; D008926:Plicamycin; C027235:gallium nitrate