Impact of Chemotherapy on Hypercalcemia in Breast and Lung Cancer Patients

Abstract

Introduction: Hypercalcemia is mainly caused by bone resorption due to either secretion of cytokines including parathyroid hormone-related protein (PTHrP) or bone metastases. However, hypercalcemia may occur in patients with or without bone metastases. The present study aimed to describe the effect of chemotherapy treatment, regimens and doses on calcium levels among breast and lung cancer patients with hypercalcemia. Methods: We carried a review of medical records of breast and lung cancer patients hospitalized in years 2003 and 2009 at Penang General Hospital, a public tertiary care center in Penang Island, north of Malaysia. Patients with hypercalcemia (defined as a calcium level above 10.5 mg/dl) at the time of cancer diagnosis or during cancer treatment had their medical history abstracted, including presence of metastasis, chemotherapy types and doses, calcium levels throughout cancer treatment, and other co-morbidity. The mean calcium levels at first hospitalization before chemotherapy were compared with calcium levels at the end of or at the latest chemotherapy treatment. Statistical analysis was conducted using the Chi-square test for categorical data, logistic regression test for categorical variables, and Spearman correlation test, linear regression and the paired sample t tests for continuous data. Results: Of a total 1,023 of breast cancer and 814 lung cancer patients identified, 292 had hypercalcemia at first hospitalization or during cancer treatment (174 breast and 118 lung cancer patients). About a quarter of these patients had advanced stage cancers: 26.4% had mild hypercalcemia (10.5-11.9 mg/dl), 55.5% had moderate (12-12.9 mg/dl), and 18.2% severe hypercalcemia (13-13.9; 14-16 mg/dl). Chemotherapy lowered calcium levels significantly both in breast and lung cancer patients with hypercalcemia; in particular with chemotherapy type 5-flurouracil+epirubicin+cyclophosphamide (FEC) for breast cancer, and gemcitabine+cisplatin in lung cancer. Conclusion: Chemotherapy decreases calcium levels in breast and lung cancer cases with hypercalcemia at cancer diagnosis, probably by reducing PTHrP levels.

Association of ABCB1, 5-HT3B Receptor and CYP2D6 Genetic Polymorphisms with Ondansetron and Metoclopramide Antiemetic Response in Indonesian Cancer Patients Treated with Highly Emetogenic Chemotherapy

“…The secondary outcome was delayed nausea and vomiting scored dichotomic (yes or no). Patients without delayed emesis (no) were defined as patients without vomiting and/or had ,5 score on the NVAS scale, while patients with delayed emesis (yes) were defined as patients with vomiting and/or scored !5 scale of NVAS (24,25).…”

Analysis on Survival and Prognostic Factors for Cancer Patients with Malignancy-associated Hypercalcemia

“…The prevalence of MAH is around 3%~30% of all cancer patients (Grill et al, 2000;Stewart et al, 2005;Buchner-Daley et al, 2012;Hassan et al, 2012;Sookprasert et al, 2012). However, the incidence of MAH in China is far below the number (Xie et al, 2006;Shi et al, 2008).…”

Hypercalcaemia in patients with breast cancer: Patterns and treatment outcomes among in-patients in a Malaysian tertiary healthcare facility

“…When serum calcium level between 10-5-11.9mg/ dL it will be considered as mild hypercalcemia. While, when it is between 12-12.9 mg/ dL it will be considered as moderate hypercalcemia, and severe hypercalcemia will be considered when calcium value is ≥13 mg/dL [3].…”

“…Hypercalcaemia can occur in cancer patients with or without bone metastasis. The main mechanism of hypercalcaemia in these patients involves pathological bone resorption through secretion of cytokines such as parathyroid hormone-related protein (PTHrP), which leads to activation and differentiation of osteoclast cells [3][4][5].…”