What drug treats hypercalcemia of malignancy?
Ibandronate – Ibandronate effectively treats hypercalcemia of malignancy. In combined trials with over 320 patients, ibandronate doses of 2 mg IV administered over two hours normalized serum calcium in up to 67 percent of patients, and doses up to 6 mg were safe and well tolerated [40,41].
How is hypercalcemia treated in cancer?
The mainstay of treatment for cancer-related hypercalcemia is hydration with normal saline and intravenous (IV) bisphosphonates. Hydration alone is not sufficient to achieve and maintain normocalcemia in cancer patients.
What is the first line treatment for hypercalcemia?
Intravenous bisphosphonates are the treatment of first choice for the initial management of hypercalcaemia, followed by continued oral, or repeated intravenous bisphosphonates to prevent relapse.
How do bisphosphonates treat hypercalcemia?
Bisphosphonates inhibit osteoclastic bone resorption and are effective in the treatment of hypercalcemia due to conditions causing increased bone resorption and malignancy-related hypercalcemia. Pamidronate and etidronate can be given intravenously, while risedronate and alendronate may be effective as oral therapy.
What causes hypercalcemia of malignancy?
The pathophysiology of hypercalcemia of malignancy is mainly through three mechanisms: excessive secretion of parathyroid hormone-related protein (PTHrP), bony metastasis with the release of osteoclast activating factors, and production of 1,25-dihydroxy vitamin D (calcitriol).
What is humoral hypercalcemia of malignancy?
Humoral hypercalcemia of malignancy (HHM) is caused by the oversecretion of parathyroid hormone-related peptide (PTHrP) from malignant tumors. Although any tumor may cause HHM, that induced by intrahepatic cholangiocarcinoma (ICC) or gastric cancer (GC) is rare.
Which malignancy is most commonly associated with hypercalcemia?
The most common cancers associated with hypercalcemia in the United States are breast, renal, and lung cancer and multiple myeloma . Malignancy is usually evident clinically by the time it causes hypercalcemia, and patients with hypercalcemia of malignancy often have a poor prognosis.
How does pheochromocytoma cause hypercalcemia?
Surgical removal of the pheochromocytoma resulted in return of catecholamine, serum calcium, and parathyroid hormone concentrations to normal. The increased catecholamines probably stimulated the parathyroid glands to produce excessive parathyroid hormone, resulting in hypercalcemia.
When does hypercalcemia need to be treated?
If calcium levels are lower than 12 mg/dL and a patient has no symptoms, it is unnecessary to treat the hypercalcemia. In patients with moderate hypercalcemia (12 to 14 mg/dL) and symptoms, specific treatment is necessary. Patients with moderate calcium level elevation but no symptoms may only need adequate hydration.
How do steroids help hypercalcemia?
Corticosteroids are the therapy of choice for cases of 1,25-dihydroxyvitamin D (calcitriol) mediated hypercalcemia. Steroids inhibit 1-α-hydroxylase conversion of 25-hydroxyvitamin D (calcidiol) into 1,25-dihydroxyvitamin D (calcitriol) therefore lessening intestinal calcium absorption.