Mori Masayuki, Shirasawa Masayuki, Oguri Akihito, Yamamoto Hiroki, Manabe Hideaki, Nakahara Yoshiro, Sato Takashi, Naoki Katsuhiko
Department of Respiratory Medicine, School of Medicine, Kitasato University, Kanagawa, Japan. Address: 1-15-1 Kitasato, Minami, Sagamihara, Kanagawa, 252-0375, Japan.
Department of Respiratory Medicine, Tachikawa Sogo Hospital, Tokyo, Japan. Address: 4-1, Midori, Tachikawa, Tokyo, 190-8578, Japan.
Respir Med Case Rep. 2025 Feb 26;54:102183. doi: 10.1016/j.rmcr.2025.102183. eCollection 2025.
Lung cancer often causes bone metastasis, and denosumab is administered to bone metastases to prevent bone-related adverse events. One of the important side effects of denosumab is hypocalcemia, but this is generally not a problem, as it is used with calcium supplementation. A 48-year-old non-smoker male was diagnosed with lung adenocarcinoma with EGFR L858R mutation with diffuse bone metastases. Three days after receiving denosumab, the patient developed weakness and numbness in his limbs and was diagnosed with drug-induced hypocalcemia due to denosumab. It takes more than 4 months for treating the hypocalcemia in this case with continuous intravenous infusion of calcium gluconate with oral calcium supplementation for 2 months of hospitalization and subsequent 2 months of outpatient treatment with intermittent intravenous infusion of calcium gluconate three times a week along with oral supplementation. Tartrate-resistant acid phosphatase-5b (TRACP-5b), a marker of bone resorption, was a biomarker for the required amount of calcium in this case. Patients with lung cancer with diffuse osteoblastic bone metastases could develop severe hypocalcemia and require long-term calcium supplementation.
肺癌常导致骨转移，地诺单抗用于骨转移以预防骨相关不良事件。地诺单抗的重要副作用之一是低钙血症，但这通常不是问题，因为它与钙剂补充联合使用。一名48岁不吸烟男性被诊断为伴有EGFR L858R突变的肺腺癌且有弥漫性骨转移。在接受地诺单抗治疗三天后，患者出现肢体无力和麻木，被诊断为地诺单抗所致药物性低钙血症。该病例持续静脉输注葡萄糖酸钙并口服钙剂，住院2个月，随后门诊治疗2个月，每周间歇性静脉输注葡萄糖酸钙三次并口服补充钙剂，治疗低钙血症耗时超过4个月。抗酒石酸酸性磷酸酶-5b（TRACP-5b）是骨吸收标志物，在此病例中是所需钙剂剂量的生物标志物。伴有弥漫性成骨性骨转移的肺癌患者可能发生严重低钙血症，需要长期补充钙剂。
