Incidence of Hypercalcemia and Vertebral Fractures Following Denosumab Withdrawal in Lung Cancer Patients: A Longitudinal Cohort Study.

Q2 Medicine
Journal of Bone Metabolism Pub Date : 2025-02-01 Epub Date: 2025-02-28 DOI:10.11005/jbm.24.803
Marta Villanova, Sharon H Chou, Le Min
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引用次数: 0

Abstract

Background: Bone-target agents (BTAs), including denosumab (DMAb), are one of the bone metastasis treatments that should continue indefinitely. However, BTAs may be interrupted in some cases. In osteoporosis, DMAb withdrawal causes a rebound effect characterized by an increased bone turnover with spine fractures and hypercalcemia; evidence of the DMAb withdrawal effect in oncology is lacking.

Methods: This study aimed to identify the DMAb withdrawal effect amongst lung cancer patients treated with DMAb for bone metastases between January 2020 and December 2021. Patients who discontinued DMAb were included. Encounter notes, radiological and laboratory findings were comprehensively reviewed.

Results: Thirty patients were included with a median follow-up of 21 months (interquartile range [IQR], 10-30) after DMAb discontinuation. Bisphosphonates were administered before starting DMAb in 7 patients (23.3%) and after DMAb withdrawal in 4 cases (13.3%). Three cases of DMAb withdrawal-related hypercalcemia and 3 cases of spine fractures following DMAb cessation were identified in 5 patients (16.7%), all of them were females and the median age was 65 years old (IQR, 65-70). No statistical difference in DMAb duration or number of injections was found in patients developing DMAb withdrawal-related spine fractures or hypercalcemia compared with others (binary logistic regression, p=0.688 and p=0.938, respectively).

Conclusions: Patients with bony-metastatic lung cancer, especially post-menopausal women, are at risk of fractures and calcium abnormalities after DMAb discontinuation, suggesting that DMAb withdrawal effect may also be present in the oncological setting. A close follow-up and careful monitoring during and after discontinuation of DMAb is necessary.

肺癌患者停用地诺单抗后高钙血症和椎体骨折的发生率:一项纵向队列研究。
背景:骨靶药物(BTAs),包括地诺单抗(DMAb),是骨转移治疗中应该无限期持续的药物之一。然而,在某些情况下,bta可能会中断。在骨质疏松症中,停用DMAb会引起反弹效应,其特征是脊柱骨折和高钙血症导致骨转换增加;肿瘤中缺乏DMAb停药效应的证据。方法:本研究旨在确定2020年1月至2021年12月期间接受DMAb治疗的骨转移肺癌患者的DMAb停药效果。停用DMAb的患者也包括在内。对偶遇记录、放射学和实验室结果进行了全面审查。结果:30例患者在停用DMAb后中位随访21个月(四分位间距[IQR], 10-30)。7例患者(23.3%)在开始服用DMAb前给予双磷酸盐,4例患者(13.3%)在停用DMAb后给予双磷酸盐。5例患者(16.7%)出现DMAb停药相关高钙血症3例,停用DMAb后脊柱骨折3例,均为女性,中位年龄65岁(IQR, 65-70)。发生DMAb停药相关脊柱骨折或高钙血症的患者与其他患者相比,DMAb持续时间或注射次数无统计学差异(二元logistic回归,p=0.688和p=0.938)。结论:骨转移性肺癌患者,尤其是绝经后妇女,在停用DMAb后存在骨折和钙异常的风险,提示DMAb停药效应可能也存在于肿瘤环境中。在停用DMAb期间和之后进行密切随访和仔细监测是必要的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Journal of Bone Metabolism
Journal of Bone Metabolism Medicine-Endocrinology, Diabetes and Metabolism
CiteScore
3.70
自引率
0.00%
发文量
23
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