Department of Diabetes & Endocrinology, Peninsula Health, Frankston VIC, 3199, Australia.
Calcif Tissue Int. 2022 Oct;111(4):391-395. doi: 10.1007/s00223-022-01002-x. Epub 2022 Jul 9.
Denosumab reduces incidence of skeletal related events in patients with bony-metastatic breast cancer, however cessation is associated with a rebound phenomenon which, rarely, has been associated with hypercalcaemia. We aimed to identify the incidence of post-denosumab cessation rebound hypercalcaemia amongst patients with breast cancer-related bony metastases. We performed a single-centre retrospective cohort analysis to determine the incident of rebound hypercalcaemia amongst patients treated with antiresorptive agents for bony metastatic breast cancer between 2016-2020. 22,320 outpatient encounters were reviewed, which identified 97 patients with bonymetastatic disease treated with antiresorptive therapy. Of the 21 patients who had denosumab ceased, six (28.6%) developed hypercalcaemia. Interval between last denosumab dose and onset of hypercalcaemia was a median 7.5 (range 2-13) months. There was a significant difference in both denosumab treatment duration as well as total treatment dose exposure between patients who developed hypercalcaemia post-denosumab cessation (median 41 months, 40 doses) and those who remained normocalcaemic (median 10 months, 5 doses), p = 0.009. In our study, hypercalcaemia occurred between two and thirteen months after denosumab cessation. Greater denosumab treatment duration as well as total denosumab dose exposure was associated with higher risk of hypercalcaemia after denosumab cessation. Hormonal therapy or previous bisphosphonate treatment was not seen to impact upon development of hypercalcaemia. Rebound hypercalcaemia is a rare but important diagnosis to consider in patients experiencing hypercalcaemia after denosumab cessation.
地舒单抗可降低骨转移乳腺癌患者骨骼相关事件的发生率，但停药后会出现反弹现象，极少数情况下与高钙血症有关。我们旨在确定乳腺癌骨转移患者停药后地舒单抗反弹性高钙血症的发生率。我们进行了一项单中心回顾性队列分析，以确定 2016-2020 年期间接受抗吸收剂治疗的骨转移乳腺癌患者中反弹性高钙血症的发生率。共回顾了 22320 次门诊就诊，其中确定了 97 例患有骨转移疾病并接受抗吸收剂治疗的患者。在停止使用地舒单抗的 21 例患者中，有 6 例（28.6%）发生高钙血症。最后一次地舒单抗剂量与高钙血症发作之间的间隔中位数为 7.5 个月（范围 2-13 个月）。在停药后发生高钙血症的患者和未发生高钙血症的患者之间，地舒单抗治疗持续时间和总治疗剂量暴露均存在显著差异（中位时间 41 个月，40 剂），p=0.009。在我们的研究中，高钙血症发生在地舒单抗停药后 2 至 13 个月之间。地舒单抗治疗持续时间更长和总地舒单抗剂量暴露更高与停药后发生高钙血症的风险增加相关。激素治疗或以前的双膦酸盐治疗似乎并未影响高钙血症的发生。停药后地舒单抗反弹性高钙血症是一种罕见但重要的诊断，需要在停药后出现高钙血症的患者中考虑。
