The following is a summary of “Treatment of Hypercalcemia of Malignancy in Adults: An Endocrine Society Clinical Practice Guideline,” published in the March 2023 issue of Endocrinology & Metabolism by Fuleihan, et al.

Although powerful chemotherapeutic agents may reduce the incidence of hypercalcemia of malignancy (HCM), the most frequent metabolic complication of malignancies, developing increasingly potent chemotherapeutic drugs has significantly reduced the high mortality rate linked to HCM. Unfortunately, although effective HCM treatments are widely accessible, there aren’t many evidence-based guidelines for managing this crippling condition. To address the gap, a group of clinical and systematic literature review experts developed guidelines for treating adults with HCM.

The panel identified eight clinical questions related to the treatment of HCM in adults and conducted systematic reviews of relevant studies. Using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology, the panel assessed the certainty of the evidence and made recommendations. An independent systematic review was also conducted to assess patients’ and physicians’ values and preferences, costs, resources needed, acceptability, feasibility, equity, and other relevant domains.

The panel recommended strong treatment of HCM in adults with denosumab or an intravenous bisphosphonate (BP). Additionally, the panel suggested conditional treatment with denosumab rather than an IV BP in adults with HCM, as well as a combination of calcitonin and an IV BP or Dmab therapy as initial treatment in adults with severe HCM. The panel also suggested using Dmab in adults with refractory or recurrent HCM despite treatment with BP and adding an IV BP or Dmab in adult patients with hypercalcemia due to tumors associated with high calcitriol levels which were already receiving glucocorticoid therapy but continued to have severe or symptomatic HCM. Finally, the panel recommended treatment with either a calcimimetic or an antiresorptive (IV BP or Dmab) for adult patients with hypercalcemia due to parathyroid carcinoma.

The guidelines highlighted the importance of treating the primary malignancy to control hypercalcemia and prevent recurrence. They provided a framework for managing HCM in adults while addressing decisional and contextual factors. The panel also identified research gaps to be addressed in future studies.

Reference: academic.oup.com/jcem/article/108/3/507/6916871