Treatment of hypercalcaemia of malignancy in adults

Abstract

Hypercalcaemia of malignancy (HCM) is a common metabolic complication of advanced malignancies with a prevalence varying from 2-30%, depending on cancer type and disease stage. HCM is associated with impaired quality of life, increased risk of hospitalisation and limited survival. Evidence-based guidelines for management of HCM have been lacking to date, despite its prevalence and detrimental impact. This concise guidance highlights key recommendations from the recent Endocrine Society Clinical Practice Guidelines on Treatment of Hypercalcaemia of Malignancy in Adults, published in December 2022. A systematic review and meta-analysis was commissioned to support the guideline development process. Key suggestions include the use of denosumab in preference to intravenous bisphosphonates as first-line treatment for HCM and the use of denosumab in cases of recurrent or refractory HCM in patients previously treated with intravenous bisphosphonates. The guideline also identifies priority areas for future research.

Keywords: antiresorptive; bisphosphonate; calcimimetic; calcitonin; cancer; denosumab; glucocorticoids; hypercalcaemia; malignancy; parathyroid cancer.

Fig 1.

Suggested workflow for the management of hypercalcaemia of malignancy. The therapeutic approach depends on both the pathophysiology and severity of hypercalcaemia. Reproduced, with permission, from Oxford University Press. BP = bisphosphonate; Dmab = denosumab; HCM = hypercalcaemia of malignancy.