Treatment of malignancy-associated hypercalcemia with cinacalcet: a paradigm shift.
Treatment of malignancy-associated hypercalcemia with cinacalcet: a paradigm shift.
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DOI：
10.1530/ec-20-0487
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发表时间：
2021-01
影响因子：
2.9
通讯作者：
Yau H
中科院分区：
文献类型：
--
作者：
O'Callaghan S;Yau H
鉴于恶性肿瘤相关高钙血症（MAH）的预后持续不佳，且与该疾病过程相关的发病率和死亡率高，缓解与MAH相关的症状对患者至关重要且具有临床意义。从历史上看，药物一直是暂时的，对患者的发病率和生存没有影响。我们建议cinacalcet可以作为一种有效的口服药物，减少患者在医院/诊所的时间。它具有良好的耐受性，可将血清钙水平维持在正常范围内，同时可采用靶向癌症治疗。这对发病率有直接、重大的影响。维持高钙血症可以提高生活质量，同时让靶向治疗有时间提高生存率。鉴于我们的病例（和其他病例）显示MAH中钙含量降低，有希望的证据表明cinacalcet可以更广泛地应用于这种情况。未来应考虑研究cinacalcet在MAH患者钙正常化、生活质量改善和生存影响方面的疗效。虽然cinacalcet在这种情况下减少钙的确切作用机制目前尚不清楚，但我们仍然可以为患者提供可能的益处。
Palliation of symptoms related to malignancy-associated hypercalcemia (MAH) is essential and clinically meaningful for patients, given the continued poor prognosis, with high morbidity and mortality associated with this disease process. Historically, agents have been temporizing, having no impact on patient morbidity nor survival. We suggest that cinacalcet can be an efficacious agent to be taken orally, reducing patients’ time in the hospital/clinic settings. It is well-tolerated and maintains serum calcium levels in the normal range, while targeted cancer treatments can be employed. This has a direct, major impact on morbidity. Maintaining eucalcemia can increase quality of life, while allowing targeted therapies time to improve survival. Given that our case (and others) showed calcium reduction in MAH, there is promising evidence that cinacalcet can be more widely employed in this setting. Future consideration should be given to studies addressing the efficacy of cinacalcet in calcium normalization, improvement of quality of life, and impact on survival in patients with MAH. Though the exact mechanism of action for cinacalcet’s reduction in calcium in this setting is not currently known, we can still afford patients the possible benefit from it.