Effect of Pamidronate on Hypercalcemia, BUN and Cr in Patients with Malignancy

Authors
Shahrbanoo Keyhanian
Maryam Zakeri Hamidi
Zahra Fotokian
Mohammad Mansoor Saravi
Shadi Saravi
Ali Saravi
Abstract
Introduction and Aims

Bone metastases have bad potential effects on the individual life period. One of these complications is hypercalcemia that cause dizziness, nausea, constipation and azotemia. Pamidronate reduces skeletal complications in patients with bone metastases. This study evaluated effect of Pamidronate on hypercalcemia BUN and Cr in cancer patients.

Materials and Methods

In this quasi-experimental study, 41 patients with malignancy referring to Ramsar Imam Sajjad hospital were selected by convenience sampling. In this study 90 mg of Pamidronate was injected intravenously monthly for 3 months. Data collection was done through demographic and clinical data questionnaire and blood samples. Data of before and after intervention were compared. Statistical analysis was performed using paired t tests, chi-square, Friedman and Wilcoxon tests with SPSS v.11.5 and P<0.05 was considered as significant.

Results

The most common cancer was breast (43.9%) and bone metastasis point in most patients (65.9%) was diffuse. The results of this study indicated that there was significant difference between serum Ca (calcium) (P=0.015), BUN (Blood Urea Nitrogen) (P=0.031), ALKP (Alkalin Phosphatase) (P=0.002) before and after treatment, but there was no significant difference between Cr (Creatinine) concentration before and after treatment (P=0.41).

Conclusion

Pamidronate is effective in prevention of hypercalcemia and decrease BUN and Cr. So, it can be used as main and routine treatment.



* Corresponding Author: Tonekabon Branch, Islamic Azad University, Faculty of Medicine.

Email: Maryamzakerihamidi@yahoo.co.nz
Keywords
pamidronate
neoplasm metastases
hypercalcemia
blood urea nitrogen
creatinine
Coleman R. Management of Bone Metastases. The Oncologist, 2000;5(6):463-70.

Wellington K, Goa KL. Zoledronic acid: A review of its use in the management of bone metastasis and hypercalcemia of malignancy. Drugs, 2003;63(4):417-37.

Theriault RL, Lipton A, Hortobagyi GN, Leff R, Gluck S, Stewart JF, et al. Pamidronate reduces skeletal morbidity in women with advanced breast cancer bone lesions: a randomized, placebo-controlled trial. Protocol 18 Aredia Breast Study Group. J Clin Oncol. 1999;17(3):846-54.

Hortobagyi GN, Theriault RL, Porter L, Blayney D, Lipton A, Sinoff C, et al. Efficacy of pamidronate in reducing skeletal complications in patients with breast cancer and lytic bone metastases. Protocol 19 Aredia Breast Study Group. N Engl J Med. 1996;335(24):1785-91.

Stewart AF. Clinical practice. Hypercalcemia associated with cancer. N Engl J Med. 2005;352(4):373-9.

Brown JE, Coleman RE. The role of Bisphosphonates in the management of patients with breast cancer. Breast cancer Res. 2001;4(1):24-9.

Seccareccia D. Cancer-related hypercalcemia. Can Fam Physician. 2010;56(3):244-6.

Singer FR. Role of the bisphosphonate etidronate in the Therapy of cancer-related hypercalcaemia. Semin Oncol. 1990;17(2):34-9.

O'Rourke NP, McCloskey EV, Kanis JA. Tumour induced hypercalcaemia: A case for active treatment. Clin Oncol. 1994;6(3):172-6.

Coleman RE. Biochemical markers of malignant bone disease. In: Rubens RD, Mundy GR, editors. Cancer and the Skeleton. London: Taylor & Francis; 2000. p.137-50.

Lipton A, Golver D, Harvey H, Grabelsky S, Zelenakas K, Macerata R, et al. Pamidronate in the treatment of bone metastatases: results of 2 doseranging trials in patients with breast cancer or prostate cancer. Ann Oncol. 1994;5:31-5.

Mancini, I. Dumon, JC. Body JJ. Efficacy and safety of ibandronate in the treatment of opioid-resistant bone pain associated with metastatic bone disease, a pilot study. J clin oncol. 2004;22(17):3587-92.

Mirels H. Metastatic disease in long bones. A proposed scoring system for diagnosing impending pathological fracture. Clin Orthop Relat Res. 1989;(249):256-64.

Conte PF, Latreille J, Mauriac L, Calabresi F, Santos R, Campos D, et al. Delay in progression of bone metastases in breast cancer patients treated with intravenous pamidronate: results from a multinational randomized controlled trial. The Aredia Multinational Cooperative Group. J Clin Oncol. 1996;14(9):2552-9.

James R Berenson. Risks of bisphosphonate therapy in patients with malignancy. [2016]; Available from: http://www.uptodate.com/contents/risks-of-bisphosphonate-therapy-in-patients-with-osteoporosis

Heatley S. Metastatic bone disease and tumour-induced hypercalcaemia: Treatment options. Int J Palliat Nurs. 2004;10(1):41-6.

Hillner BE, Weeks JC, Desch CE, Smith TJ. Pamidronate in prevention of bone complications in metastatic breast cancer: a cost-effectiveness analysis. J Clin Oncol. 2000;18(1):72-9.

Sng A, Loke KY, Lim Y, Ho Cindy. Pamidronate therapy for hypercalcemia of childhood malignancy. Int J Pediatr Endocrinol. 2015;2015:56.

Trimarchi H, Lombi F, Forrester M, Elizondo C, Sawinski D, Pereyra H, et al. Disodium pamidronate for treating severe hypercalcemia in a hemodialysis patient. Nat Clin Pract Nephrol. 2006;2(8):459-63.

Major P, Lortholary A, Hon J, Abdi E, Mills G, Menssen HD, et al. Zoledronic acid is superior to pamidronate in the treatment of hypercalcemia of malignancy: a pooled analysis of two randomized, controlled clinical trials. J Clin Oncol. 2001;19(2):558-67.

Berenson JR, Lichtenstein A, Porter L, Dimopoulos MA, Bordoni R, George S, et al. Efficacy of pamidronate in reducing skeletal events in patients with advanced multiple myeloma. N Engl J Med. 1996;334(8):488-93.