Assessment of frequency and severity of hypomagnesemia in patients with metastatic colorectal cancer treated with cetuximab, with a review of the literature

Abstract

Abstract. Currently, there are a few systemic treatment options for patients with metastatic colorectal cancer (mCRC). Targeted therapy used in this setting includes the use of monoclonal antibodies, such as cetuximab or panitumumab, directed against epidermal growth factor receptor. The aim of the present study was to estimate the frequency and severity of hypomagnesemia among patients with mCRC treated with cetuximab. The data from the Department of Clinical Oncology, University Hospital of Krakow (Krakow, Poland), concerning 52 patients treated between 2009 and 2013 were collected. Of these, 27 patients fulfilled the inclusion criteria to enter this retrospective study. The National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0 were used to grade the level of hypomagnesemia. In total, 29.6% of all patients experienced hypomagnesemia during treatment, and the majority of cases were grade 1 (22.2%). There was no statistically significant correlation between magnesium (Mg) level and patient age, duration of treatment, localization of primary tumor or metastases, and the number of metastases. However, there was an upward trend in a logistic regression model showing that the risk of developing hypomagnesemia increases with age. Hypomagnesemia is a frequent problem among mCRC patients receiving cetuximab. It is essential to introduce guidelines regarding the monitoring of the Mg level and its supplementation in this group of patients.

Adverse Renal Effects of Novel Molecular Oncologic Targeted Therapies: A Narrative Review

“…Of the cases, 22% were grade 1 (i.e., below the lower limit of normal to 1.2 mg/dl). 57 There was no statistically significant correlation between Mg level and patient age, duration of treatment, localization of primary tumor or metastases, and number of metastases. However, there was an upward trend in a logistic regression model showing that the risk of developing hypomagnesemia increases with age.…”

“…However, there was an upward trend in a logistic regression model showing that the risk of developing hypomagnesemia increases with age. 57 Management of EGFR inhibitor−induced hypomagnesemia is summarized by Fakih in a review. 58 One has to ensure that the patient is not on any other offending medication, such as thiazide diuretics or proton pump inhibitors.…”

Research progress on common adverse events caused by targeted therapy for colorectal cancer (Review)

“…Hypomagnesemia is negatively associated with age, potentially due to the easier loss of Mg 2+ ( 61 , 62 ). Furthermore, severe hypomagnesemia may lead to changes in muscle strength (including cramps, muscle weakness and ataxia), heart lesions (including coronary spasms, arrhythmia and long Q-T syndrome) and psychotic symptoms (including epilepsy, insanity, depression and anxiety) ( 63 ).…”

Risk Evaluation of Proton Pump Inhibitors for Panitumumab-Related Hypomagnesemia in Patients with Metastatic Colorectal Cancer

“…Univariate logistic regression analyses were conducted to assess odds ratios (ORs) and 95% confidence intervals (CIs). Previously reported potential risk factors for hypomagnesemia, including PPI use, 6) age, 7) renal impairment, 8) and diuretics, 9) were examined. In before the propensity score-matched cohort, factors of p < 0.25 in univariate analyses were evaluated as potential covariates in a stepwise multivariate logistic regression with backward selection.…”

“…Previous studies have identified other risk factors for hypomagnesemia, including the use of proton pump inhibitors (PPIs), 6) age, 7) renal impairment, 8) and diuretics. 9) Several reports have highlighted that concomitant use of PPIs can elevate the risk of hypomagnesemia in cancer patients receiving panitumumab and cetuximab.…”