Cetuximab therapy and symptomatic hypomagnesemia Journal Article
| Authors: | Schrag, D.; Chung, K. Y.; Flombaum, C.; Saltz, L. |
| Article Title: | Cetuximab therapy and symptomatic hypomagnesemia |
| Abstract: | We report that patients treated with cetuximab, a monoclonal antibody against the epithelial growth factor receptor (EGFR), occasionally develop a magnesium wasting syndrome with inappropriate urinary excretion. We first observed this phenomenon in a 34-year-old male patient with metastatic colorectal cancer who developed profound fatigue and symptomatic hypocalcemia and hypomagnesemia while on cetuximab plus irinotecan therapy. Other medications with the potential to cause magnesium wasting had not been administered. Intravenous magnesium supplementation was required for the duration of cetuximab therapy, but electrolyte abnormalities resolved after discontinuation of treatment. This case prompted review of serum chemistry reports for a consecutive case series of 154 colorectal cancer patients treated with cetuximab. Thirty-four patients (22%) had at least one serum magnesium measurement during cetuximab treatment, and six had grade 3 (< 0.9 mg/dL) and two had grade 4 (< 0.7 mg/dL) hypomagnesemia. Because EGFR is strongly expressed in the kidney, particularly in the ascending limb of the loop of Henle where 70% of filtered magnesium is reabsorbed, EGFR blockade may interfere with magnesium transport. Because symptoms may be rapidly ameliorated with supplementation, we suggest that, when fatigue or hypocalcemia is encountered during cetuximab therapy, serum magnesium level be measured and repleted as necessary. © The Author 2005. Published by Oxford University Press. All rights reserved. |
| Keywords: | adult; major clinical study; fatigue; paresthesia; review; case report; bevacizumab; cisplatin; fluorouracil; diarrhea; drug withdrawal; antineoplastic agents; antineoplastic agent; colorectal cancer; metabolism; metastasis; drug eruption; antineoplastic combined chemotherapy protocols; incidence; epidermal growth factor receptor; camptothecin; calcium; receptor, epidermal growth factor; cetuximab; irinotecan; monoclonal antibody; hypomagnesemia; colorectal neoplasms; hospitalization; blood; antibodies, monoclonal; drug antagonism; severity of illness index; chemically induced disorder; colorectal tumor; folinic acid; acne; drug derivative; liver disease; symptomatology; receptor blocking; oxaliplatin; tacrolimus; metabolic disorder; epidermal growth factor receptor antibody; diuretic agent; magnesium sulfate; electrolyte disturbance; hypocalcemia; case study; supplementation; magnesium; hand disease; aminoglycoside; urinary excretion; blood chemistry; wasting syndrome; amphotericin; fasciculation; magnesium blood level; magnesium deficiency |
| Journal Title: | JNCI: Journal of the National Cancer Institute |
| Volume: | 97 |
| Issue: | 16 |
| ISSN: | 0027-8874 |
| Publisher: | Oxford University Press |
| Date Published: | 2005-08-17 |
| Start Page: | 1221 |
| End Page: | 1224 |
| Language: | English |
| DOI: | 10.1093/jnci/dji242 |
| PUBMED: | 16106027 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 99" - "Export Date: 24 October 2012" - "CODEN: JNCIA" - "Source: Scopus" |
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