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Letters |19 June 2012

Denosumab for Tumor-Induced Hypercalcemia Complicated by Renal Failure

Anneke Bech, MD; Hans de Boer, MD, PhD

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Author, Article, and Disclosure Information
  • From Rijnstate Hospital, 6800 TA Arnhem, the Netherlands.

    Potential Conflicts of Interest: None disclosed.

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Background: Multiple myeloma is characterized by development of osteolytic bone lesions induced by myeloma cells that produce cytokines. The cytokines activate preosteoblastic stromal cells to secrete the receptor activator of nuclear factor-κ ligand (RANK-L). This is a key signal to stimulate osteoclast formation and activity (1). Increased bone resorption may lead to hypercalcemia in more than 30% of patients with multiple myeloma.
Standard treatment of cancer-induced hypercalcemia comprises forced hydration, calcitonin, and intravenous first-line bisphosphonates. In patients with cancer who have creatinine clearance less than 60 mL/min per 1.73 m2, bisphosphonates can cause deterioration of renal function in about 20% of cases. Use of bisphosphonates is discouraged in patients with creatinine clearance less than 30 mL/min per 1.73 m2(1, 2), which considerably reduces the number of treatment options for patients with hypercalcemia and renal failure.
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Bech A, de Boer H. Denosumab for Tumor-Induced Hypercalcemia Complicated by Renal Failure. Ann Intern Med. ;156:906–907. doi: 10.7326/0003-4819-156-12-201206190-00026

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Published: Ann Intern Med. 2012;156(12):906-907.

DOI: 10.7326/0003-4819-156-12-201206190-00026

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