Comparison of aminohydroxypropylidene diphosphonate, mithramycin, and corticosteroids/calcitonin in treatment of cancer-associated hypercalcaemia

• Published in: The Lancet (British edition) Vol. 2; no. 8461; p. 907
• Main Authors: Ralston, S H, Gardner, M D, Dryburgh, F J, Jenkins, A S, Cowan, R A, Boyle, I T
• Format: Journal Article
• Language: English
• Published: England 26.10.1985
• Subjects: Calcitonin - administration & dosage; Calcitonin - therapeutic use; Calcium - blood; Calcium - urine; Clinical Trials as Topic; Creatinine - blood; Diphosphonates - therapeutic use; Diphosphonates - urine; Drug Therapy, Combination; Humans; Hypercalcemia - blood; Hypercalcemia - drug therapy; Hypercalcemia - etiology; Hypercalcemia - urine; Neoplasms - blood; Neoplasms - complications; Pamidronate; Plicamycin - therapeutic use; Prednisolone - administration & dosage; Prednisolone - therapeutic use; Random Allocation
• ISSN: 0140-6736

Thirty-nine patients with cancer-associated hypercalcaemia were randomly allocated to receive aminohydroxypropylidene diphosphonate (APD), mithramycin, or corticosteroids and salmon calcitonin. Corticosteroids/calcitonin had the fastest calcium-lowering effect, owing mainly to an acute reduction in renal tubular calcium reabsorption; continued therapy over 9 days failed to suppress accelerated bone resorption, however, and most patients remained hypercalcaemic. Mithramycin also substantially reduced serum calcium within 24 h. A further dose on day 2 generally controlled hypercalcaemia until day 6 by reducing both bone resorption and renal tubular calcium reabsorption. By day 9, however, about 50% of the mithramycin-treated patients had started to relapse as bone resorption increased again. With APD serum calcium levels fell more slowly but progressively owing to effective suppression of bone resorption; by day 9 the control of hypercalcaemia was significantly better than in the other treatment groups. Symptoms of hypercalcaemia were greatly relieved, especially by APD.