title: Impact of chemotherapy on hypercalcemia in breast and lung cancer patients.
abstract: BACKGROUND
  Hypercalcemia is mainly caused by bone resorption due to either secretion of cytokines including parathyroid hormone-related protein (PTHrP) or bone metastases. However, hypercalcemia may occur in patients with or without bone metastases. The present study aimed to describe the effect of chemotherapy treatment, regimens and doses on calcium levels among breast and lung cancer patients with hypercalcemia.
  
  
  METHODS
  We carried a review of medical records of breast and lung cancer patients hospitalized in years 2003 and 2009 at Penang General Hospital, a public tertiary care center in Penang Island, north of Malaysia. Patients with hypercalcemia (defined as a calcium level above 10.5 mg/dl) at the time of cancer diagnosis or during cancer treatment had their medical history abstracted, including presence of metastasis, chemotherapy types and doses, calcium levels throughout cancer treatment, and other co-morbidity. The mean calcium levels at first hospitalization before chemotherapy were compared with calcium levels at the end of or at the latest chemotherapy treatment. Statistical analysis was conducted using the Chi-square test for categorical data, logistic regression test for categorical variables, and Spearman correlation test, linear regression and the paired sample t tests for continuous data.
  
  
  RESULTS
  Of a total 1,023 of breast cancer and 814 lung cancer patients identified, 292 had hypercalcemia at first hospitalization or during cancer treatment (174 breast and 118 lung cancer patients). About a quarter of these patients had advanced stage cancers: 26.4% had mild hypercalcemia (10.5-11.9 mg/dl), 55.5% had moderate (12-12.9 mg/dl), and 18.2% severe hypercalcemia (13-13.9; 14-16 mg/dl). Chemotherapy lowered calcium levels significantly both in breast and lung cancer patients with hypercalcemia; in particular with chemotherapy type 5-flurouracil+epirubicin+cyclophosphamide (FEC) for breast cancer, and gemcitabine+cisplatin in lung cancer.
  
  
  CONCLUSIONS
  Chemotherapy decreases calcium levels in breast and lung cancer cases with hypercalcemia at cancer diagnosis, probably by reducing PTHrP levels.
authors.affiliation: Clinical Pharmacy Discipline, School of Pharmaceutical Sciences, University Sains Malaysia, Minden Penang, Malaysia. bassamsunny@yahoo.com
authors.forename: Bassam Abdul Rasool
authors.initials: BA
authors.lastname: Hassan
authors.forename: Zuraidah Binti Mohd
authors.initials: ZB
authors.lastname: Yusoff
authors.forename: Mohamed Azmi
authors.initials: MA
authors.lastname: Hassali
authors.forename: Saad Bin
authors.initials: SB
authors.lastname: Othman
authors.forename: Elisabete
authors.initials: E
authors.lastname: Weiderpass
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000097:blood* / Q000556:secondary; D001943:Breast Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000473:pathology; D002118:Calcium / Q000097:blood; D016009:Chi-Square Distribution; D002945:Cisplatin / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000627:therapeutic use; D003841:Deoxycytidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D004164:Diphosphonates / Q000627:therapeutic use; D000077143:Docetaxel; D015251:Epirubicin / Q000627:therapeutic use; D005260:Female; D005472:Fluorouracil / Q000627:therapeutic use; D006801:Humans; D006934:Hypercalcemia / Q000097:blood* / Q000188:drug therapy* / Q000209:etiology; D007093:Imidazoles / Q000627:therapeutic use; D016014:Linear Models; D016015:Logistic Models; D008175:Lung Neoplasms / Q000097:blood* / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008875:Middle Aged; D000077268:Pamidronate; D044162:Parathyroid Hormone-Related Protein / Q000097:blood; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D043823:Taxoids / Q000627:therapeutic use; D055815:Young Adult; D000077211:Zoledronic Acid; D000093542:Gemcitabine
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates; D007093:Imidazoles; D044162:Parathyroid Hormone-Related Protein; D043823:Taxoids; D003841:Deoxycytidine; D000077143:Docetaxel; D015251:Epirubicin; D000077211:Zoledronic Acid; D003520:Cyclophosphamide; D000077268:Pamidronate; D002945:Cisplatin; D002118:Calcium; D005472:Fluorouracil; D000093542:Gemcitabine