Severe Hypocalcemia due to Denosumab in Metastatic Prostate Cancer Essay

Severe Hypocalcemia due to Denosumab in Metastatic Prostate Cancer Essay

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Hypocalcemia is a rare and dangerous side effect of the drug Denosumab. We present a case of a patient with metastatic prostate cancer who developed severe hypocalcemia after the administration of the drug. A total of 80 gm of intravenous and 370 gm of oral calcium were administered in vain and a maximum ionized calcium level attained was 0.71mmol/ during the first 16 days of hospital stay. Due to worsening renal failure from tumor spread our patient needed dialysis to achieve normal calcium levels. Checking calcium and Vitamin D levels prior to administration of Denosumab is very vital in preventing this adverse outcome. By presenting this case we emphasize on the importance of checking Vitamin D levels prior to administration of the drug and also make other clinicians aware of a potential severe life threatening electrolyte imbalance.

Denosumab is a fully human monoclonal antibody, administered subcutaneously, that inhibits osteoclast mediated bone resorption in bone metastases from solid tumors and multiple myeloma. See Fig A below for details.

A 45-year-old gentleman with a 3-year history of metastatic (bone, liver & lymph nodes) prostate cancer and Hypertension presented to the hospital with worsening leg swelling and hematuria. He had been treated with androgen deprivation therapy in the past, along with 3 doses of zoledronic acid for bone metastases. The bone pains were not controlled with the above regimen and hence he was switched to Denosumab. Vitals at admission were within normal limits except Blood pressure of 160/90 mmHg. Pertinent findings on physical examination were the presence of bilateral lower extremity edema and negative Chvostek and Trousseaus’s signs. Review of symptoms was positive for hematuria and leg ...


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...ence and risk of denosumab-related hypocalcemia in cancer patients: a systematic review and pooled analysis of randomized controlled studies. Qi WX, Lin F, He AN, Tang LN, Shen Z, Yao Y.
3. Severe Hypocalcemia Following Denosumab Injection in a Hemodialysis PatientBrendan B. McCormick, MD, Janet Davis, MD, and Kevin D. Burns, MD
4. Pharmaceuticals and Medical Devices Agency.: ‹http://www.info.pmda.go.jp/kinkyu_anzen/file/kinkyu20120911_1.pdf›, cited 19 April, 2013
5. Paller CJ, Carducci M, Philips G. Management of bone metastases in refractory prostate cancer—role of denosumab. Clin. Interv. Aging, 7, 363–372 (2012).

6. Buonerba C, Caraglia M, Malgieri S, Perri F, Bosso D, Federico P, Ferro M, Rizzo M, Palmieri G, Di Lorenzo G. Calcitriol: a better option than vitamin D in denosumab-treated patients with kidneyfailure? Expert Opin. Biol. Ther., 13, 149–151 (2013).

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