Maliakal Pius, Ledford Andrea
M.D. Anderson Cancer Center Orlando, Orlando, FL 32806, USA.
Exp Ther Med. 2010 Mar;1(2):307-311. doi: 10.3892/etm_00000047. Epub 2010 Mar 1.
Electrolytic changes in blood have been associated with the use of anti-epidermal growth factor receptor (EGFR) antibodies. The objective of this retrospective study was to compare the rate of incidence and the severity of blood electrolyte and protein imbalances occurring in patients receiving cetuximab or panitumumab with or without concurrent chemotherapy. Treatment data of 58 patients who received cetuximab and 21 patients who received panitumumab were analyzed. Cetuximab caused hypomagnesemia in more than half of the patients, among whom 4 had severity up to grade 2/3 level, whereas panitumumab induced hypomagnesemia in 90% of the patients with severity up to grade 2 level occurring in 38% of the patients. Intravenous magnesium supplementation on the day of anti-EGFR treatment did not always adequately control the magnesium wasting in these patients. Often treatments with these agents had to be interrupted or terminated as a result of severe electrolyte depletion despite supplementation. Taking into consideration the mechanism of magnesium wasting from the kidney and the magnesium transport process in the gut, intravenous magnesium infusion coupled with oral supplementation with more tolerant oral magnesium products may help improve the treatment outcome in these patients. Surprisingly, more than half of these patients showed significant decreases in their albumin levels, which were correlated with the initiation or discontinuation of anti-EGFR therapy. The underlying mechanism of this decrease in albumin level is not known. The increased likelihood of poor outcomes such as mortality, morbidity and prolonged hospital stay in acutely ill patients with hypoalbuminemia is well recognized. Moreover, the maintenance of adequate serum albumin levels in these patients receiving anti-EGFR therapy may play an important role in containing some of the adverse effects of concurrently administered chemotherapeutic agents.
血液中的电解质变化与抗表皮生长因子受体（EGFR）抗体的使用有关。这项回顾性研究的目的是比较接受西妥昔单抗或帕尼单抗治疗的患者（无论是否同时接受化疗）中血液电解质和蛋白质失衡的发生率及严重程度。分析了58例接受西妥昔单抗治疗的患者和21例接受帕尼单抗治疗的患者的治疗数据。西妥昔单抗导致超过半数患者出现低镁血症，其中4例严重程度达2/3级；而帕尼单抗导致90%的患者出现低镁血症，38%的患者严重程度达2级。在抗EGFR治疗当天静脉补充镁并不能总是充分控制这些患者的镁流失。尽管进行了补充，但由于严重的电解质耗竭，这些药物的治疗常常不得不中断或终止。考虑到肾脏镁流失的机制以及肠道中的镁转运过程，静脉输注镁并联合使用耐受性更好的口服镁产品进行口服补充，可能有助于改善这些患者的治疗效果。令人惊讶的是，超过半数的这些患者白蛋白水平显著下降，这与抗EGFR治疗的开始或停止有关。白蛋白水平下降的潜在机制尚不清楚。低白蛋白血症的急性病患者出现诸如死亡、发病和住院时间延长等不良结局的可能性增加，这是众所周知的。此外，在这些接受抗EGFR治疗的患者中维持足够的血清白蛋白水平，可能在控制同时使用的化疗药物的一些不良反应方面发挥重要作用。
