title: The effects of denosumab on calcium profiles in advanced cancer patients with bone metastases.
abstract: OBJECTIVE
  To retrospectively examine the incidence and management of hypocalcemia for patients with bone metastases treated with denosumab.
  
  
  METHODS
  Patients who had a record of filling a prescription of denosumab for treatment of bone metastases at the outpatient pharmacy at the Odette Cancer Centre from May 2011 to February 2013 were included in the analysis. Demographic information, previous bisphosphonate usage, calcium and albumin values, and adverse events were obtained using the Sunnybrook Electronic Patient Record system (EPR) and the Oncology Symptom Control and Information Resource (OSCIR). Hypocalcemia was defined as a calcium value below 2.0 mmol/L within a 28-day±7-day window after the last injection of denosumab based on the Common Terminology Criteria for Adverse Events (CTCAE) grade 2 hypocalcemia.
  
  
  RESULTS
  A total of 55 patients had record of a prescription for denosumab filled with an average age of 62 years (range 40 to 93 years), 18 (32.7%) were males and 37 (67.3%) were females. Twenty-nine (52.7%) patients had primary breast cancer, 12 (21.8%) prostate, 10 (18.2%) lung, and 4 (7.3%) with other types. Using CTCAE grading of hypocalcemia, 17 (32.7%) patients experienced grade 1, 4 (7.7%) patients grade 2, 4 (7.7%) patients grade 3, and 1 (1.9%) patient grade 4. The number of injections before the incident of hypocalcemia was a median of one injection (range 1 to 14). Time from the first hypocalcemia lab value to normocalcemia was a median of 33 days.
  
  
  CONCLUSIONS
  This study found that 9 of 52 (17.3%) patients had at least one incidence of hypocalcemia of grade 2 or higher after receiving denosumab. Cautionary measures should be taken to avoid hypocalcemia in patients receiving denosumab.
authors: Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, Canada, M4N 3M5.
authors: Breanne
authors: B
authors: Lechner
authors: Carlo
authors: C
authors: DeAngelis
authors: Noreen
authors: N
authors: Jamal
authors: Urban
authors: U
authors: Emmenegger
authors: Natalie
authors: N
authors: Pulenzas
authors: Angie
authors: A
authors: Giotis
authors: Parker
authors: P
authors: Sheehan
authors: May
authors: M
authors: Tsao
authors: Gillian
authors: G
authors: Bedard
authors: Edward
authors: E
authors: Chow
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D061067:Antibodies, Monoclonal, Humanized / Q000009:adverse effects* / Q000627:therapeutic use; D050071:Bone Density Conservation Agents / Q000009:adverse effects / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000097:blood* / Q000188:drug therapy* / Q000556:secondary; D001943:Breast Neoplasms / Q000097:blood / Q000188:drug therapy / Q000473:pathology; D002118:Calcium / Q000097:blood; D000069448:Denosumab; D005260:Female; D006801:Humans; D006996:Hypocalcemia / Q000139:chemically induced* / Q000188:drug therapy; D015994:Incidence; D008175:Lung Neoplasms / Q000097:blood / Q000188:drug therapy / Q000473:pathology; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000097:blood / Q000188:drug therapy / Q000473:pathology; D012189:Retrospective Studies
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D050071:Bone Density Conservation Agents; D000069448:Denosumab; D002118:Calcium