Effect of oral magnesium supplementation on the kinetics of magnesium wasting induced by EGFR targeted antibody therapy for colorectal carcinoma (MAGNET trial)

Piessevaux, Hubert; Demey, Wim; Bols, Alain; Janssens, J; Polus, Marc; Kalantari, H Rezaei; Laurent, Stéphanie; Demols, A.; Humblet, Yves; Deboever, Guido; Samani, KK; Ferrante, Michel; Monsaert, Els; Rondou, Tim; Laethem, Jean Luc Van; Tejpar, Sabine

doi:10.1093/annonc/mdy300.118

Cited by 2 publications

(3 citation statements)

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“…Recently, the MAGNET trial reported that prophylactic strategy (as opposed to reactive) of oral Mg gluconate reduced Mg wasting when administered to patients with advanced colorectal cancer treated with EGFRIs. 21 This trial was successful in randomizing 171 patients and therefore may be a more feasible setting compared to a reactive randomization as was the case in our study.…”

Section: Discussionmentioning

confidence: 63%

Oral magnesium supplements for cancer treatment‐induced hypomagnesemia: Results from a pilot randomized trial

Awan

Basulaiman

Stober

et al. 2021

Health Science Reports

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Background and Aims Optimal management of cancer treatment‐induced hypomagnesemia (hMg) is not known. We assessed the feasibility of using a novel pragmatic clinical trials model to compare two commonly used oral Mg replacement strategies. Methods Patients with grade 1 to 3 hMg while receiving either platinum‐based chemotherapy or epidermal growth factor receptor inhibitors (EGFRI) were randomized to oral magnesium oxide (MgOx) or oral magnesium citrate (MgCit). The trial methodology utilized the integrated consent model. Feasibility would be successful if; accrual rate was ≥5 patients a month and if measures of patient and physician engagement, were > 50%. Secondary endpoints included; comparison of Mg levels, cardiac arrhythmias, and rates of treatment delay/hospitalizations. Results From July 2016 to December 2017, an average of 1 patient a month was accrued. All 15 eligible and approached patients consented to participate in the study (100% engagement) and 7/15 were randomized to MgOx and 8/15 to MgCit. The percentage of physicians who approached patients for the study was 4 of 6 (66.6% engagement). The mean slope of change in Mg (mmol/L/day) was 0.0022 (95% CI: −0.0001 to 0.0044) for MgOx and 0.0006 (95% CI, −0.0012 to 0.0024) for MgCit (P = .2123). Three patients (20%) required IV magnesium while on the study (2 MgCit and 1 MgOx). Grade 1 diarrhea occurred in 3 patients in the MgCit arm. Conclusion Despite oral magnesium tolerability and meeting most of its feasibility endpoints, this study did not meet its target accrual rate. Alternative designs would be necessary for a definitive efficacy study.

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Section: Discussionmentioning

confidence: 63%

Oral magnesium supplements for cancer treatment‐induced hypomagnesemia: Results from a pilot randomized trial

Awan

Basulaiman

Stober

et al. 2021

Health Science Reports

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“…From a management perspective, physiologic studies and prospective trials support the use prophylactic oral MG supplementation at initiation of EGFRIs, or early after hMG develops. 39,45 These studies also show that oral supplements appear to be well tolerated and the requirement for IV MG may be avoided or delayed until more severe hMG develops. Due to the variable availability of MG supplements across the world, a specific MG supplement cannot be universally recommended; however, a diet high in MG and upward titration of oral MG supplementation is suggested to saturate intestinal MG concentrations for paracellular absorption.…”

Section: Management Of Epidermal Growth Factor Receptor-induced Hypomagnesaemiamentioning

confidence: 82%

“…Recently, the results of the randomised multicentre MAGNET trial became available, which focused on early oral MG supplementation. 45 Eighty-nine patients were randomised to a reactive strategy of oral MG gluconate 3 g twice daily (BID) at the occurrence of Grade 1 hMG, while 84 patients were randomised to a prophylactic strategy of oral MG gluconate 3 g BID at initiation of EGFRI and increasing to 6 g six times a day at Grade 1 hMG. The slope of decline of MG was significantly steeper with the reactive strategy, and 13% developed hMG in the reactive arm compared with only 4% in the prophylactic arm.…”

Section: Management Of Epidermal Growth Factor Receptor-induced Hypomagnesaemiamentioning

confidence: 99%

Epidermal Growth Factor Receptor Inhibitor-Induced Hypomagnesaemia: Is There a Best Replacement Strategy?

Siddiqui

Ahmed

Vickers

2021

EMJ

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Monoclonal antibodies targeting the epidermal growth factor receptor (EGFRI), such as cetuximab and panitumumab, are commonly used systemic therapies for advanced colorectal and head and neck cancers. Hypomagnesaemia is a common side effect of these therapies and occurs in up to 30% of patients. Interruption of EGFR signalling in the distal convoluted tubule leads to inactivation of the transcellular transporter transient receptor potential channel melastatin member 6 and increased renal magnesium excretion. This paper describes the incidence, risk factors, and the emerging management options for EGFRI-induced hypomagnesaemia.

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Effect of oral magnesium supplementation on the kinetics of magnesium wasting induced by EGFR targeted antibody therapy for colorectal carcinoma (MAGNET trial)

Cited by 2 publications

References 0 publications

Oral magnesium supplements for cancer treatment‐induced hypomagnesemia: Results from a pilot randomized trial

Oral magnesium supplements for cancer treatment‐induced hypomagnesemia: Results from a pilot randomized trial

Epidermal Growth Factor Receptor Inhibitor-Induced Hypomagnesaemia: Is There a Best Replacement Strategy?

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