hypercalcemia of malignancy

Question 1

zoledronic acid

Answer 1

Zometa

• inhibits bone resorption by stopping osteoclast function
• 4mg IV once, may repeat in 7 days if needed
• do not infuse over <15 minutes due to increased risk of renal toxicity
• requires renal dose adjustment starting at CrCl <60mL/min
• onset 24-72 hours
• duration of action 2-4 weeks

Question 2

pamidronate

Answer 2

Aredia

• inhibits bone resorption by stopping osteoclast function
• 60-90mg IV over 2-24h once, may repeat in 7 days if needed
• onset 24-72 hours
• duration of action 2-4 weeks

Question 3

Zometa MOA

Answer 3

• inhibits bone resorption via action on osteoclasts or osteoclast precursors
• inhibits osteoclastic activity and skeletal calcium release induced by tumors
• decreases serum calcium and phosphorus and increases their elimination

Question 4

symptoms of hypercalcemia of malignancy

Answer 4

• nausea
• vomiting
• fatigue
• dehydration
• renal failure
• mental status changes

Question 5

Hypercalcemia of malignancy commonly occurs in which cancers?

Answer 5

• breast cancer
• lung cancer
• multiple myeloma

Question 6

denosumab

Answer 6

Xgeva

• monoclonal antibody that blocks the interaction between RANKL and RANK (a receptor on osteoclasts) preventing osteoclast formation
• 120mg SC on days 1, 8, 15 of first month, then monthly
• onset 24-72 hours
• duration of action approximately 1 month