Treatment of hypercalcemia of malignancy in adults: Endocrine Society guidelines
USA: A recent article published in the Journal of Clinical Endocrinology & Metabolism reports the Endocrine Society's clinical practice guideline on treating hypercalcemia of malignancy (HCM) in adults.
Hypercalcemia of malignancy is the most frequent metabolic complication of malignancies, but due to potent chemotherapeutic agents, its incidence may be declining. The high mortality linked with HCM has declined remarkably due to the introduction of increasingly effective chemotherapeutic drugs. There is still a lack of evidence-based recommendations for managing HCM despite the widespread availability of efficacious medications to treat this debilitating condition. Therefore, Ghada El-Hajj Fuleihan, American University of Beirut, Beirut, Lebanon, and colleagues aimed to develop guidelines for treating adults with HCM.
A multidisciplinary panel of clinical experts and experts in the systematic literature review developed the guideline.
Recommendation1: Treatmentwith an intravenous (IV) bisphosphonate (BP) or denosumab (Dmab) compared withmanagement without an intravenous (IV) bisphosphonate (BP) or denosumab (Dmab)is recommended for adults with HCM
Recommendation2: Treatment with denosumab over an IV bisphosphonate is suggested.
Recommendation3: A combination of calcitonin and an IV bisphosphonate or denosumab as initialtreatment compared with only IV bisphosphonate or denosumab is suggested foradults with severe hypercalcemia of malignancy (serum calcium [SCa] >14 mg/dL).
Recommendation4: In adults with refractory/recurrent hypercalcemia of malignancy on an IVbisphosphonate, the panel suggest using denosumab compared withmanagement without denosumab.
Recommendation5: In adults with hypercalcemia of malignancy from tumors associated with highcalcitriol levels, such as lymphomas, who are already receiving glucocorticoidtherapy but who continue to have severe or symptomatic hypercalcemia, the panel suggest the addition of an IV bisphosphonate or denosumab compared withmanagement without an IV bisphosphonate or denosumab.
Recommendation6: The panel suggest treatment with either a calcimimetic or an IVbisphosphonate or denosumab in adult patients with hypercalcemia due toparathyroid carcinoma.
Recommendation7: The panel suggest adding an IV bisphosphonate or denosumab comparedwith management without an IV BP or Dmab in adult patients withhypercalcemia due to parathyroid carcinoma not adequately controlled despitetreatment with a calcimimetic.
Recommendation8: The addition of a calcimimetic compared with management without acalcimimetic is suggested in adult patients with hypercalcemia due toparathyroid carcinoma who are not adequately controlled on an intravenousbisphosphonate or denosumab therapy.
"The recommendations are based on currently available evidence considering the most important outcomes in HCM to patients and key stakeholders," the authors wrote. "Treatment of the primary malignancy is instrumental in controlling hypercalcemia and preventing its recurrence."
The recommendations provide a framework for the medical management of adults with HCM and incorporate important contextual and decisional factors. The guidelines underscore current knowledge gaps that can be used to establish future research agendas.
Reference:
Ghada El-Hajj Fuleihan, Gregory A Clines, Mimi I Hu, Claudio Marcocci, M Hassan Murad, Thomas Piggott, Catherine Van Poznak, Joy Y Wu, Matthew T Drake, Treatment of Hypercalcemia of Malignancy in Adults: An Endocrine Society Clinical Practice Guideline, The Journal of Clinical Endocrinology & Metabolism, 2022;, dgac621, https://doi.org/10.1210/clinem/dgac621
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