Denosumab-induced hypocalcaemia in metastatic castrate-resistant prostate cancer. (12th December 2019)

• Record Type: Journal Article
• Authors: Gunawan, Florence; George, Elizabeth; Kotowicz, Mark
• Is Part Of: Endocrinology, diabetes & metabolism case reports. (2019)
• Publication Date: 2019-12-12
• Subjects: Adult -- Male -- White -- Australia; Bone -- Bone -- PTH -- Hypocalcaemia -- Iatrogenic disorder -- Prostate cancer -- Adenocarcinoma; Fatigue -- Paraesthesia -- Cramps -- Pancytopaenia -- Calcium (serum) -- Calcium (urine) -- Alkaline phosphatase -- Liver function -- Magnesium -- PTH -- Phosphate (serum) -- Pro-collagen 1* -- C-telopeptide -- Albumin -- Denosumab -- Calcium carbonate -- Cholecalciferol -- Calcium gluconate -- Calcium citrate* -- Calcitriol -- Hydrochlorothiazide -- Dexamethasone; Oncology; Unique/unexpected symptoms or presentations of a disease -- December -- 2019; Endocrinology -- Periodicals; Diabetes -- Periodicals; Diabetes Mellitus; Endocrinology; Diabetes; Endocrinology; Case Reports; Periodicals; Periodicals; 616.4
• DOI: 10.1530/EDM-19-0063
• Languages: English
• ISSNs: 2052-0573

Abstract

Abstract : Summary: Denosumab is a fully human MAB that acts as a potent anti-resorptive by inhibiting activation of osteoclasts by inhibiting the receptor activator of nuclear factor-kappa B (RANK) ligand. Hypocalcaemia has been reported as one of the serious adverse sequelae of use of denosumab. We present a case of refractory hypocalcaemia following administration of a single dose of denosumab in a patient with metastatic castrate-resistant prostate cancer. The patient's serum calcium and vitamin D concentrations and renal function were normal prior to denosumab administration. Serum alkaline phosphatase (ALP) level was however elevated pre-morbidly consistent with known bone metastases. The patient was treated with high-dose oral and IV calcium without any appreciable response in serum calcium. During his 30-day hospital admission, he demonstrated disease progression with development of new liver metastases and bone marrow involvement. Normocalcaemia was not achieved despite 1 month of aggressive therapy. Given the patient was asymptomatic and prognosis guarded, he was eventually discharged for ongoing supportive care under the palliative care team. Learning points: Denosumab is a potent anti-resorptive therapy and hypocalcaemia is one of the known adverse effects. Serum calcium and vitamin D concentrations must be replete prior to administration of denosumab to reduce the risk of hypocalcaemia. Denosumab has been proven to be more effective than zoledronic acid in preventing skeletal-related adverse effects in patients with metastatic castrate-resistant prostate cancer.