Severe and prolonged hypocalcemia after a single dose of denosumab for metastatic breast cancer with diffuse bone involvement without prior calcium/vitamin D supplementations

2020 ◽  
pp. 107815522096455
Author(s):  
So Jung Uhm ◽  
James A Hall ◽  
Jon D Herrington
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Vitamin D ◽  
Single Dose ◽  
Bone Metastasis ◽  
Bone Disease ◽  
Human Monoclonal Antibody ◽  
Metastatic Breast ◽  
Metastatic Bone Disease ◽  
Poor Renal Function

Introduction Denosumab is a human monoclonal antibody antiresorptive agent used for the treatment of bone metastasis in different cancer types, including breast cancer. Hypocalcemia is a known adverse effect of denosumab, and early supplementation plays an important role in the prevention and management of hypocalcemia. Case report A 63-year-old female with stage IV estrogen receptor-positive breast cancer with diffuse bone metastasis experienced severe, prolonged hypocalcemia following a single dose of denosumab. The patient also had several risk factors for denosumab-associated hypocalcemia. Despite not receiving additional doses of denosumab, the patient required multiple hospitalizations and outpatient infusions of calcium to resolve her symptomatic hypocalcemia. Management and outcome: Severe hypocalcemia associated with denosumab can be prevented or mitigated by recognizing the risk factors for hypocalcemia and supplementing with vitamin D/calcium. Proposed risk factors include poor renal function, hypoparathyroidism, insufficient calcium intake, and diffuse metastatic bone disease. Studies suggest that early supplementation before starting denosumab can lower this risk. Discussion Several cases of severe hypocalcemia associated with denosumab have been reported. However, to the authors’ knowledge, this is the first report that highlights the importance of early vitamin D/calcium supplementations for a patient with diffuse metastatic bone disease with pre-existing low levels of calcium.

Vitamin D insufficiency and risk of paclitaxel-induced peripheral neuropathy.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e12027-e12027
Author(s):  
Theodore Salvatore Jennaro ◽  
Ellen M. Lavoie Smith ◽  
Kiran Vangipuram ◽  
Kelley M. Kidwell ◽  
Monika Leigh Burness ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Risk Factors ◽  
Vitamin D ◽  
Metastatic Breast Cancer ◽  
Peripheral Neuropathy ◽  
Assessment Tool ◽  
Metastatic Breast ◽  
Vitamin D Insufficiency ◽  
Primary Analysis ◽  
Patient Reported

e12027 Background: Peripheral neuropathy (PN) is a severe, dose-limiting toxicity of paclitaxel that occurs in up to 25% of patients and can lead to permanent loss of balance and manual dexterity. Due to the lack of effective strategies for PN prevention or treatment, there is a critical need to identify predictive risk factors for paclitaxel-induced PN. Vitamin insufficiencies are known risk factors for PN in other disease states. However, the effect of vitamin insufficiency on paclitaxel-induced PN has not been adequately investigated. Methods: Baseline levels of vitamin D and other nutrients (vitamin B, homocysteine, folate) were measured, and PN was assessed weekly in an observational trial of patients receiving paclitaxel 80 mg/m2 for 12 weeks for non-metastatic breast cancer (NCT0233811). Nutrient levels were measured by Michigan Medicine and insufficiency defined by institutional standards (vitamin D insufficiency < 20 ng/mL). In the primary analysis, the maximum increase from baseline in the 8-item sensory subscale (ΔCIPN8) of the EORTC CIPN20, a validated patient-reported PN assessment tool, was compared in nutrient insufficient and sufficient patients. The effect of vitamin insufficiencies on PN-induced treatment disruptions (dose decrease, delay, or discontinuation) was conducted as a secondary analysis. Results: Only vitamin D insufficiency was identified in enough patients for analysis (15/37 = 41%). Vitamin D insufficient patients reported a greater mean (+/- SD) ΔCIPN8 (36.39 ±22.8) than vitamin D sufficient patients (16.29 ±16.3) (p = 0.003). However, the increase in treatment disruption for vitamin D insufficient patients was not significant (OR = 2.98, 95% CI [0.72, 12.34], p = 0.16). Conclusions: Paclitaxel-treated patients who were vitamin D insufficient at baseline had greater increases in patient-reported PN. If validated in larger studies, vitamin D insufficiency may be a clinically translatable, modifiable risk factor that can be used to prevent paclitaxel-induced PN in patients with non-metastatic breast cancer.

Serum activinA and TGF-β as biomarkers of breast cancer bone metastasis behavior.

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 10620-10620
Author(s):  
Christina L. Addison ◽  
Nathaniel Bouganim ◽  
Huijun Zhao ◽  
Lisa Vandermeer ◽  
Sasha Mazzarello ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Regression Analysis ◽  
Bone Metastasis ◽  
Bone Metastases ◽  
Bone Disease ◽  
Linear Regression Analysis ◽  
Metastatic Bone Disease ◽  
Individual Risk ◽  
Bone Resorption Marker ◽  
The Government

10620 Background: Bisphosphonates (BP) are prescribed to pts with metastatic bone disease every 3-4 weeks regardless of individual risk for skeletal related events (SREs). In an era of personalized medicine this “one size fits all” approach is not appropriate and novel markers of SRE risk are required. TRIUMPH is an ongoing clinical trial evaluating 12 weekly IV BP therapy for 1 year in women with low risk bone metastases from breast cancer (BC) as defined by the bone resorption marker C-telopeptide (CTx,) levels <600 ng/L. This sub-study evaluated the utility of novel biomarkers in better predicting the risk of developing SREs. Methods: Serum obtained from pts at baseline and 6 weeks post-entry were analyzed for tumor growth factor-β (TGF-β) and activinA levels by ELISA (sensitivity ~15-30 pg/ml). Levels were correlated with pt parameters including time to development of bone metastasis, and number of previous SREs using linear regression analysis. Changes in levels of biomarkers from baseline to 6 weeks were used to calculate odds ratios using logistic regression analysis. Results: Baseline activinA correlated with baseline CTx and bone specific alkaline phosphatase (p=0.004 and p<0.0001 respectively). Baseline activinA also correlated with weight (p=0.02), BMI (p=0.007) and trended towards total number of prior SREs (p=0.07). Baseline TGF-β correlated with pt age (p=0.02), weight (0.006), BMI (p=0.0005) and duration of metastatic bone disease (p=0.004), but did not correlate with any other biomarker. Change in activinA (baseline to week 6) was the only biomarker that trended to predict coming off study early (p=0.053) as per protocol (i.e. CTx>600 ng/ml, SREs or pt/physician choice). Conclusions: Baseline levels of activinA trended to predict incidence of SREs in patients with bone metastases, and changes in levels from baseline to 6 weeks trended to predict coming off study early. These findings warrant future studies in BC pts assessing activinA as a predictor of risk associated with breast cancer bone metastases. This study was conducted with the support of the Ontario Institute for Cancer Research through funding provided by the Government of Ontario, and with funding from the Ontario Chapter of the Canadian Breast Cancer Foundation.

scholarly journals Characteristic of risk factor of thyroid cancer related metastatic bone disease at Sanglah General Hospital Denpasar between January 2013 to March 2019

2020 ◽  
Vol 8 (4) ◽  
pp. 1430
Author(s):  
Gede Ketut Alit Satria Nugraha ◽  
I. Gede Eka Wiratnaya ◽  
Gde Dedy Andika ◽  
Made Sunaria
Keyword(s):  
Risk Factors ◽  
Thyroid Cancer ◽  
Bone Metastasis ◽  
Thyroid Carcinoma ◽  
General Hospital ◽  
Bone Disease ◽  
Female Gender ◽  
Metastatic Bone Disease ◽  
Follicular Neoplasm ◽  
Pathological Result

Background: Metastatic bone disease (MBD) causes a massive morbidity, pain, and disability for the sufferers. Thyroid carcinoma, which is the most common endocrine cancer worldwide, also contributes to the increased rate of MBD, as 60% of patients with thyroid carcinoma experience bone metastasis. An urgency to further analyze the risk factors of bone metastasis in thyroid cancer is necessary in order to prevent and treat this unwanted occurrence earlier and better.Methods: A descriptive retrospective study was conducted using patients’s medical record data obtained from Sanglah General Hospital between January 2013 until March 2019. The variables obtained were sex, age, diagnosis, management, and fracture site.Results: There were 15 patients involved in this study, presenting with pathological fracture due to MBD from thyroid cancer. Ten patients were female (66.7%)  and 5 were male (33.3%). According to the age group, 2 patients (13.3%) were <40 years old, 5 patients (33.3%) were >60 years old, while the majority of 8 patients (53.4%) were 40-60 years old. From the pathological result, 9 patients had follicular neoplasm (60%) and 5 patients had papillary neoplasm (33%). The most common site of metastasis was humerus in 7 patients (47%), while the other sites were femur, pelvic, and tibia.Conclusions: According to this series, there are several risk factors related to MBD from thyroid carcinoma, including female gender, the age of 40-60 years old, and follicular type neoplasm. A further study with bigger amount of sample is needed to improve the result.

Symptomatic hypocalcemia following a single dose of zoledronic acid in a patient with bone metastases secondary to breast cancer

2020 ◽  
pp. 107815522094041
Author(s):  
Hasan Sözel ◽  
Fatih Yilmaz
Keyword(s):  
Breast Cancer ◽  
Vitamin D ◽  
Single Dose ◽  
Zoledronic Acid ◽  
Vitamin D Deficiency ◽  
Metastatic Breast ◽  
Post Menopausal Osteoporosis ◽  
Symptomatic Hypocalcemia ◽  
Precautionary Measures ◽  
Post Menopausal

Introduction The use of bisphosphonates is increasing, for treatment of hypercalcemia and pain in cancer, and post-menopausal osteoporosis and also to decrease the risk of skeletal morbidity in multiple myeloma and metastatic breast cancer. Case report A single dose of zoledronic acid was administered for hypercalcemia in a 54-year-old woman breast cancer patient with extensive bone metastasis. After the first dose, the patient developed symptomatic hypocalcemia. Management and outcome: Simultaneous hypocalcemia, hypophosphatemia, and vitamin D deficiency were detected in the patient. In the symptomatic process, intravenous, then oral replacement was performed. Discussion There is a need for taking precautionary measures such as vitamin D, serum phosphorus and, calcium monitoring and supplementation to prevent life-threatening complications, such as symptomatic hypocalcemia, especially in populations with vitamin D deficiency like ours.

scholarly journals Successful application of focused extracorporeal shockwave therapy for plantar fasciitis in patients suffering from metastatic breast cancer

2021 ◽  
Author(s):  
Andrej Zdravkovic ◽  
Michael Mickel ◽  
Richard Crevenna
Keyword(s):  
Breast Cancer ◽  
Cancer Patients ◽  
Bone Disease ◽  
Plantar Fasciitis ◽  
Metastatic Breast ◽  
Metastatic Bone Disease ◽  
Heel Pain ◽  
Bone Lesions ◽  
Extracorporeal Shock Wave ◽  
The Subject

Abstract Purpose Focused extracorporeal shock wave therapy (fESWT) has been shown to be effective in a large number of musculoskeletal disorders. Until 2016, cancer was considered a contraindication for fESWT. The goal of this Commentary is to address the subject of fESWT in cancer patients and present a case of a successful application of fESWT in a breast cancer patient with metastatic bone disease, suffering from debilitating heel pain caused by plantar fasciitis. Methods The subject of fESWT application in cancer patients is discussed using the example of a 75-year-old female with breast cancer and metastatic bone disease suffering from bilateral inferior heel pain, who was referred to our clinic with a tentative diagnosis of polyneuropathy. Patient history, clinical examination, electrodiagnostic testing, and radiological findings all indicated plantar fasciitis, rather than polyneuropathy. The possibility of metastatic bone lesions in the treatment area was excluded and the patient was thereupon treated with 5 weekly applications of low-energy fESWT. Results The treatment lead to a reduction in pain of approximately 80% with no adverse events. Conclusion fESWT may be a viable treatment option for plantar fasciitis even in cancer patients, provided certain conditions are met.

scholarly journals Breast Cancer with Bone Metastasis: Molecular Insights and Clinical Management

Cells ◽  
2021 ◽  
Vol 10 (6) ◽  
pp. 1377
Author(s):  
Konstantinos Venetis ◽  
Roberto Piciotti ◽  
Elham Sajjadi ◽  
Marco Invernizzi ◽  
Stefania Morganti ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Metastasis ◽  
Clinical Management ◽  
Bone Destruction ◽  
Metastatic Breast ◽  
Breast Cancer Patients ◽  
Incurable Condition ◽  
Skeletal Related Events ◽  
Relevant Topic ◽  
Systemic Therapies

Despite the remarkable advances in the diagnosis and treatment of breast cancer patients, the presence or development of metastasis remains an incurable condition. Bone is one of the most frequent sites of distant dissemination and negatively impacts on patient’s survival and overall frailty. The interplay between tumor cells and the bone microenvironment induces bone destruction and tumor progression. To date, the clinical management of bone metastatic breast cancer encompasses anti-tumor systemic therapies along with bone-targeting agents, aimed at slowing bone resorption to reduce the risk of skeletal-related events. However, their effect on patients’ survival remains controversial. Unraveling the biology that governs the interplay between breast neoplastic cells and bone tissue would provide means for the development of new therapeutic agents. This article outlines the state-of-the art in the characterization and targeting the bone metastasis in breast cancer, focusing on the major clinical and translational studies on this clinically relevant topic.

scholarly journals BOMET-QoL-10 questionnaire for breast cancer patients with bone metastasis: the prospective MABOMET GEICAM study

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
A. Barnadas ◽  
◽  
M. Muñoz ◽  
M. Margelí ◽  
J. I. Chacón ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Quality Of Life ◽  
Health Status ◽  
Bone Metastasis ◽  
Assessment Tool ◽  
Metastatic Breast ◽  
Perceived Health ◽  
Perceived Health Status ◽  
Patient Reported

Abstract Background Bone metastasis (BM) is the most common site of disease in metastatic breast cancer (MBC) patients. BM impacts health-related quality of life (HRQoL). We tested prospectively the psychometric properties of the Bone Metastasis Quality of Life (BOMET-QoL-10) measure on MBC patients with BM. Methods Patients completed the BOMET-QoL-10 questionnaire, the Visual Analogue Scale (VAS) for pain, and a self-perceived health status item at baseline and at follow-up visits. We performed psychometric tests and calculated the effect size of specific BM treatment on patients´ HRQoL. Results Almost 70% of the 172 patients reported symptoms, 23.3% experienced irruptive pain, and over half were receiving chemotherapy. BOMET-QoL-10 proved to be a quick assessment tool performing well in readability and completion time (about 10 min) with 0–1.2% of missing/invalid data. Although BOMET-QoL-10 scores remained fairly stable during study visits, differences were observed for patient subgroups (e.g., with or without skeletal-related events or adverse effects). Scores were significantly correlated with physician-reported patient status, patient-reported pain, symptoms, and perceived health status. BOMET-QoL-10 scores also varied prospectively according to changes in pain intensity. Conclusions BOMET-QoL-10 performed well as a brief, easy-to-administer, useful, and sensitive HRQoL measure for potential use for clinical practice with MBC patients. Trial registration NCT03847220. Retrospectively registered on clinicaltrials.gov (February the 20th 2019).

Pain reduction with oral and intravenous ibandronate treatment for metastatic bone disease of breast cancer

Bone ◽  
2006 ◽  
Vol 38 (3) ◽  
pp. 77-78
Author(s):  
A.A. Kurth ◽  
J. Seraphin ◽  
F. Schütze ◽  
A. Nusch ◽  
I. Schäfer ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Bone Disease ◽  
Pain Reduction ◽  
Metastatic Bone Disease
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