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성인 고형암 환자의 고칼슘혈증 치료현황과 치료효과 분석

Real-world Treatment Pattern and Outcomes of Hypercalcemia among Solid Tumor Patients

한국임상약학회지 2019년 29권 3호 p.166 ~ 172
신다은 ( Shin Da-Eun ) - 서울대학교병원 약제부

박설희 ( Park Seol-Hee ) - 서울대학교병원 약제부
김성환 ( Kim Sung-Hwan ) - 서울대학교병원 약제부
서성연 (  ) - 서울대학교병원 약제부
조윤희 ( Jo Yun-Hee ) - 서울대학교병원 약제부
조윤숙 (  ) - 서울대학교병원 약제부
임석아 ( Im Seock-Ah ) - 서울대학교 의과대학 내과학교실
이주연 ( Lee Ju-Yeun ) - 서울대학교 약학대학

Abstract


Background: Hypercalcemia is an important metabolic emergency condition in cancer patients. Bisphosphonate is the treatment of choice for hypercalcemia, whereas calcitonin and hydration with furosemide are recommended for acute supportive therapy. However, data regarding real-world treatment patterns and outcomes of pharmacological treatments are limited. Therefore, we aimed to investigate the treatment patterns and clinical outcomes of hypercalcemia treatment in solid tumor patients.

Methods: Electronic medical records of 123 adults with solid cancers and albumin-corrected calcium levels >10.5 mg/dL or ionized calcium levels >1.35 mmol/L were reviewed. We retrospectively analyzed the pharmacological treatment and recovery rate according to the severity of hypercalcemia.

Results: A total of 177 cases were identified, of which 49 were not treated and 30 were treated with hydration only. In moderate-to-severe cases, 86.5% received pharmacological treatment. Thirty-four cases (19.2%) were treated with bisphosphonate alone and 58 cases (32.8%) were treated with bisphosphonate and calcitonin. In mild hypercalcemia cases, the recovery rate was higher for those receiving hydration only or pharmacological treatment (79.7%) than for those receiving no treatment (61.4%, p = 0.041). Most moderate-to-severe cases were treated with medication and of those treated, 56.3% recovered. The recovery rate was lower in those treated with bisphosphonate alone (38.2%) than in those who underwent calcitonin combination treatment (73.7%, p = 0.001).

Conclusions: Bisphosphonate combined with calcitonin was found to be more effective than bisphosphonate alone for the treatment of moderate-to-severe hypercalcemia. Considering the current shortage of calcitonin, further efforts are required to ensure its stable supply.

키워드

osphonate; calcitonin; hypercalcemia; neoplasms
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