Tetany: Possible adverse effect of bevacizumab

Anwikar, Shraddha; Bandekar, M S; Patel, Tejas; Patel, Parimal; Na, Kshirsagar

doi:10.4103/0019-509x.75819

Cited by 5 publications

(3 citation statements)

References 11 publications

(8 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…There has been only one study which described seven patients on bevacizumab who developed tetany-like symptoms, one of whom presented with jaw stiffness. [2] However, both sunitinib and bevacizumab are associated with osteonecrosis of the jaw in patients with renal cell carcinoma, both in conjunction with but also independent of simultaneous bisphosphonate therapy. [3] This indicates that these agents can penetrate bone tissue and that the mandible appears to be particularly susceptible to their effects, as osteonecrosis in other bony sites secondary to TKI use is rare.…”

Section: Discussionmentioning

confidence: 99%

Induction of trismus by sunitinib and pazopanib in metastatic renal cell carcinoma

Iyer¹,

Montgomery²,

Pandha³

2017

Indian J Urol

View full text Add to dashboard Cite

Tyrosine kinase inhibitors sunitinib and pazopanib are used as first-line agents in the treatment of metastatic renal cell carcinoma. Treatment-related toxicities have been described with both these drugs. This report describes a patient with metastatic renal carcinoma who developed trismus while being treated with these agents and is, to the best of our knowledge, the first such case to be reported.

show abstract

Section: Discussionmentioning

confidence: 99%

Induction of trismus by sunitinib and pazopanib in metastatic renal cell carcinoma

Iyer¹,

Montgomery²,

Pandha³

2017

Indian J Urol

View full text Add to dashboard Cite

show abstract

“…Bevacizumab, a humanized anti-angiogenic monoclonal antibody used for the treatment of colorectal cancer, can cause tetany-related symptoms by interfering with calcium metabolism. 87 Other mechanisms may be associated with hypomagnesemia and hypokalemia. 87 The severit y and rapidit y of the development of hypocalcemia are responsible for latent and overt features of tetany.…”

Section: Pathophysiology Electrolytes and Acid-base Balancementioning

confidence: 99%

“…87 Other mechanisms may be associated with hypomagnesemia and hypokalemia. 87 The severit y and rapidit y of the development of hypocalcemia are responsible for latent and overt features of tetany. In GS, BS, and VDD, latent tetany is common.…”

Section: Pathophysiology Electrolytes and Acid-base Balancementioning

confidence: 99%

Spectrum of Disorders associated with Tetany

Santra¹

2023

JAPI

View full text Add to dashboard Cite

Introduction: Awareness regarding the etiological spectrum of tetany is poor among physicians. Because of poor awareness, tetany is underdiagnosed and undertreated. Materials and methods: Databases like PubMed, PubMed Central, Scopus, and Google Scholar are searched to identify peer-reviewed articles on tetany. Case reports, case series, and original articles are analyzed to identify different causes of tetany prevalent in the community. Different causes found are analyzed and tabulated, and finally, a flowchart is made on the approach for diagnosing different underlying pathologies of tetany. Results: Both metabolic and respiratory alkalosis are important causes of tetany because of reduced ionized calcium levels. Gitelman syndrome (GS) is associated with metabolic alkalosis, hypokalemia, hypomagnesemia and hypocalciuria, and frequently causes normocalcemic tetany. Recurrent vomiting and primary hyperaldosteronism also cause tetany due to metabolic alkalosis. Hyperventilation syndrome (HVS) leads to respiratory alkalosis and is a frequent cause of tetany. Hyperventilation-induced tetany is also seen after spinal anesthesia and in respiratory disorders like asthma. Vitamin D deficiency (VDD), primary hypoparathyroidism, and pseudohypoparathyroidism (PHP) (1a, 1b, and 2) cause hypocalcemic tetany. Hypomagnesemia causes hypocalcemia and tetany due to peripheral parathyroid hormone resistance and impaired parathyroid hormone secretion. Drugs causing tetany include bisphosphonates, denosumab, cisplatin, antiepileptics, aminoglycosides, diuretics, etc. Tetany is also seen in acute pancreatitis, dengue, falciparum malaria, hyperemesis gravidarum, tumor lysis syndrome (TLS), massive blood transfusion, etc. Conclusion: The spectrum of disorders associated with tetany is diverse. Awareness of different causes will help early and proper diagnosis of tetany.

show abstract

Bevacizumab or fibronectin gene editing inhibits the osteoclastogenic effects of fibroblasts derived from human radicular cysts

Wang

Chen

et al. 2018

Acta Pharmacol Sin

View full text Add to dashboard Cite

Fibronectin (FN) is a main component of extracellular matrix (ECM) in most adult tissues. Under pathological conditions, particularly inflammation, wound healing and tumors, an alternatively spliced exon extra domain A (EDA) is included in the FN protein (EDA + FN), which facilitates cellular proliferation, motility, and aggressiveness in different lesions. In this study we investigated the effects of EDA + FN on bone destruction in human radicular cysts and explored the possibility of editing FN gene or blocking the related paracrine signaling pathway to inhibit the osteoclastogenesis. The specimens of radicular cysts were obtained from 20 patients. We showed that the vessel density was positively associated with both the lesion size (R = 0.49, P = 0.001) and EDA + FN staining (R = 0.26, P = 0.022) in the specimens. We isolated fibroblasts from surgical specimens, and used the CRISPR/Cas system to knockout the EDA exon, or used IST-9 antibody and bevacizumab to block EDA + FN and VEGF, respectively. Compared to control fibroblasts, the fibroblasts from radicular cysts exhibited significantly more Trap + MNCs, the relative expression level of VEGF was positively associated with both the ratio of EDA + FN/total FN (R = 0.271, P = 0.019) and with the number of Trap + MNCs (R = 0.331, P = 0.008). The knockout of the EDA exon significantly decreased VEGF expression in the fibroblasts derived from radicular cysts, leading to significantly decreased osteoclastogenesis; similar results were observed using bevacizumab to block VEGF, but block of EDA + FN with IST-9 antibody had no effect. Furthermore, the inhibitory effects of gene editing on Trap + MNC development were restored by exogenous VEGF. These results suggest that EDA + FN facilitates osteoclastogenesis in the fibrous capsule of radicular cysts, through a mechanism mediated by VEGF via an autocrine effect on the fibroblasts. Bevacizumab inhibits osteoclastogenesis in radicular cysts as effectively as the exclusion of the EDA exon by gene editing.

show abstract

Tetany: Possible adverse effect of bevacizumab

Abstract: Tetany should be considered as a one of the signs. Patient on bevacizumab should carefully watch for tetany-related symptoms and calcium and magnesium levels for their safety.

Cited by 5 publications

References 11 publications

Induction of trismus by sunitinib and pazopanib in metastatic renal cell carcinoma

Induction of trismus by sunitinib and pazopanib in metastatic renal cell carcinoma

Spectrum of Disorders associated with Tetany

Bevacizumab or fibronectin gene editing inhibits the osteoclastogenic effects of fibroblasts derived from human radicular cysts

Contact Info

Product

Resources

About