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Published in: International Journal of Clinical Oncology 2/2017

01-04-2017 | Original Article

Incidence of hypophosphatemia in advanced cancer patients: a recent report from a single institution

Authors: Taichi Yoshida, Daiki Taguchi, Koji Fukuda, Kazuhiro Shimazu, Masahiro Inoue, Katsunori Murata, Hiroyuki Shibata

Published in: International Journal of Clinical Oncology | Issue 2/2017

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Abstract

Background

Recent approval of molecular-targeted agents has contributed to improving the therapeutic outcomes of advanced cancer patients. However, they result in unusual adverse events that rarely occur with cytotoxic agents, such as hypertension, hypomagnesemia, and an acne-like rash. Although hypophosphatemia can be induced by various agents, some kinds of molecular-targeted agents are known to induce it. In addition, cancer survivors may be at a risk of hypophosphatemia.

Methods

One hundred and seventy patients, who visited the Department of Clinical Oncology at Akita University from 1 April 2014 to 31 August 2016 were enrolled in this study after providing informed consent. Serum inorganic phosphorus levels were examined along with other routine clinical examinations. Correlation between the serum inorganic phosphorus level and other clinical data were also analyzed.

Results

Grade ≥2 severe hypophosphatemia (<2.5 mg/dL of phosphorus) was detected in 49.4% of patients, and grade ≥3 (<2.0 mg/dL of phosphorus) was observed in 22.9% patients. These results indicated that the presence of bone metastasis (p < 0.001), history of bone-modifying agents (p < 0.001) and molecular-targeted drugs (p = 0.001), and time from the date of the first visit to the date of minimum serum phosphorus level (p < 0.001) might correlate with hypophosphatemia. Multivariate logistic regression analysis showed that disease duration might be a risk factor (p = 0.0466).

Conclusion

As hypophosphatemia can be induced by various factors in advanced cancer patients, the serum phosphorus level of cancer patients at risk should be cautiously examined.
Literature
1.
go back to reference Allemani C, Allemani C, Weir HK et al (2015) CONCORD Working Group. Global surveillance of cancer survival 1995–2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 385:977–1010CrossRefPubMed Allemani C, Allemani C, Weir HK et al (2015) CONCORD Working Group. Global surveillance of cancer survival 1995–2009: analysis of individual data for 25,676,887 patients from 279 population-based registries in 67 countries (CONCORD-2). Lancet 385:977–1010CrossRefPubMed
2.
go back to reference Welch S, Spithoff K, Rumble RB et al (2010) Bevacizumab combined with chemotherapy for patients with advanced colorectal cancer: a systematic review. Ann Oncol 21:1152–1162CrossRefPubMed Welch S, Spithoff K, Rumble RB et al (2010) Bevacizumab combined with chemotherapy for patients with advanced colorectal cancer: a systematic review. Ann Oncol 21:1152–1162CrossRefPubMed
3.
go back to reference Spratlin JL, Cohen RB, Eadens M et al (2010) Phase I pharmacologic and biologic study of ramucirumab (IMC-1121B), a fully human immunoglobulin G1 monoclonal antibody targeting the vascular endothelial growth factor receptor-2. J Clin Oncol 28:780–787CrossRefPubMedPubMedCentral Spratlin JL, Cohen RB, Eadens M et al (2010) Phase I pharmacologic and biologic study of ramucirumab (IMC-1121B), a fully human immunoglobulin G1 monoclonal antibody targeting the vascular endothelial growth factor receptor-2. J Clin Oncol 28:780–787CrossRefPubMedPubMedCentral
4.
go back to reference Grothey A (2006) Recognizing and managing toxicities of molecular targeted therapies for colorectal cancer. Oncology 20:21–28PubMed Grothey A (2006) Recognizing and managing toxicities of molecular targeted therapies for colorectal cancer. Oncology 20:21–28PubMed
5.
go back to reference McLellan B, Ciardiello F, Lacouture ME et al (2015) Regorafenib-associated hand-foot skin reaction: practical advice on diagnosis, prevention, and management. Ann Oncol 26:2017–2026CrossRefPubMedPubMedCentral McLellan B, Ciardiello F, Lacouture ME et al (2015) Regorafenib-associated hand-foot skin reaction: practical advice on diagnosis, prevention, and management. Ann Oncol 26:2017–2026CrossRefPubMedPubMedCentral
6.
go back to reference Lipton A, Fizazi K, Stopeck AT et al (2012) Superiority of denosumab to zoledronic acid for prevention of skeletal-related events: a combined analysis of 3 pivotal, randomised, phase 3 trials. Eur J Cancer 48:3082–3092CrossRefPubMed Lipton A, Fizazi K, Stopeck AT et al (2012) Superiority of denosumab to zoledronic acid for prevention of skeletal-related events: a combined analysis of 3 pivotal, randomised, phase 3 trials. Eur J Cancer 48:3082–3092CrossRefPubMed
7.
go back to reference Ryan EA, Reiss E (1984) Oncogenous osteomalacia. Review of the world literature of 42 cases and report of two new cases. Am J Med 77:501–512CrossRefPubMed Ryan EA, Reiss E (1984) Oncogenous osteomalacia. Review of the world literature of 42 cases and report of two new cases. Am J Med 77:501–512CrossRefPubMed
8.
go back to reference Berman E, Nicolaides M, Maki RG et al (2006) Altered bone and mineral metabolism in patients receiving imatinib mesylate. N Engl J Med 354:2006–2013CrossRefPubMed Berman E, Nicolaides M, Maki RG et al (2006) Altered bone and mineral metabolism in patients receiving imatinib mesylate. N Engl J Med 354:2006–2013CrossRefPubMed
12.
go back to reference Whyte MP, Liberman UA (2011) Rickets and osteomalacia (acquired and heritable forms) and skeletal dysplasias. In: Wass J, Stewart PM (eds) Oxford textbook of endocrinology and diabetes, 2nd edn. Oxford University Press, New York, pp 743–744 Whyte MP, Liberman UA (2011) Rickets and osteomalacia (acquired and heritable forms) and skeletal dysplasias. In: Wass J, Stewart PM (eds) Oxford textbook of endocrinology and diabetes, 2nd edn. Oxford University Press, New York, pp 743–744
14.
go back to reference Jan DeBeur SM, Finnegan RB, Vassiliadis J et al (2002) Tumors associated with oncogenic osteomalacia express genes important in bone and mineral metabolism. J Bone Miner Res 17:1102–1110CrossRef Jan DeBeur SM, Finnegan RB, Vassiliadis J et al (2002) Tumors associated with oncogenic osteomalacia express genes important in bone and mineral metabolism. J Bone Miner Res 17:1102–1110CrossRef
15.
go back to reference Rosner MH, Dalkin AC (2014) Electrolyte disorders associated with cancer. Adv Chronic Kidney Dis 21:7–17CrossRefPubMed Rosner MH, Dalkin AC (2014) Electrolyte disorders associated with cancer. Adv Chronic Kidney Dis 21:7–17CrossRefPubMed
16.
go back to reference Urakawa I, Yamazaki Y, Shimada T et al (2006) Klotho converts canonical FGF receptor into a specific receptor for FGF23. Nature 444:770–774CrossRefPubMed Urakawa I, Yamazaki Y, Shimada T et al (2006) Klotho converts canonical FGF receptor into a specific receptor for FGF23. Nature 444:770–774CrossRefPubMed
17.
go back to reference Guy JM, Stewart MF, Olukoga A et al (1999) Hypophosphataemia in general practice patients. Ann Clin Biochem 36(Pt 1):37–42CrossRefPubMed Guy JM, Stewart MF, Olukoga A et al (1999) Hypophosphataemia in general practice patients. Ann Clin Biochem 36(Pt 1):37–42CrossRefPubMed
18.
go back to reference Bech A, Blans M, Telting D et al (2013) Incidence and etiology of renal phosphate loss in patients with hypophosphatemia in the intensive care unit. Intensive Care Med 39:1785–1791CrossRefPubMed Bech A, Blans M, Telting D et al (2013) Incidence and etiology of renal phosphate loss in patients with hypophosphatemia in the intensive care unit. Intensive Care Med 39:1785–1791CrossRefPubMed
19.
go back to reference Bringhurst FR, Demay MB, Krane SM et al (2008) Bone and mineral metabolism in health and disease. In: Fauci AS et al (eds) Harrison’s principles of internal medicine, 17th edn. Mac GrawHill, New York, pp 2365–2377 Bringhurst FR, Demay MB, Krane SM et al (2008) Bone and mineral metabolism in health and disease. In: Fauci AS et al (eds) Harrison’s principles of internal medicine, 17th edn. Mac GrawHill, New York, pp 2365–2377
21.
go back to reference Kono N, Kuwajima M, Tarui S (1981) Alteration of glycolytic intermediary metabolism in erythrocytes during diabetic ketoacidosis and its recovery phase. Diabetes 30:346–353CrossRefPubMed Kono N, Kuwajima M, Tarui S (1981) Alteration of glycolytic intermediary metabolism in erythrocytes during diabetic ketoacidosis and its recovery phase. Diabetes 30:346–353CrossRefPubMed
22.
go back to reference Brautbar N, Leibovici H, Massry SG (1983) On the mechanism of hypophosphatemia during acute hyperventilation: evidence for increased muscle glycolysis. Miner Electrolyte Metab 9:45–50PubMed Brautbar N, Leibovici H, Massry SG (1983) On the mechanism of hypophosphatemia during acute hyperventilation: evidence for increased muscle glycolysis. Miner Electrolyte Metab 9:45–50PubMed
23.
go back to reference Zamkoff KW, Kirshner JJ (1980) Marked hypophosphatemia associated with acute myelomonocytic leukemia. Indirect evidence of phosphorus uptake by leukemic cells. Arch Intern Med 140:1523–1524CrossRefPubMed Zamkoff KW, Kirshner JJ (1980) Marked hypophosphatemia associated with acute myelomonocytic leukemia. Indirect evidence of phosphorus uptake by leukemic cells. Arch Intern Med 140:1523–1524CrossRefPubMed
24.
go back to reference Perek J, Mittelman M, Gafter U et al (1984) Hypophosphatemia accompanying blastic crisis in a patient with malignant lymphoma. J Cancer Res Clin Oncol 108:351–353CrossRefPubMed Perek J, Mittelman M, Gafter U et al (1984) Hypophosphatemia accompanying blastic crisis in a patient with malignant lymphoma. J Cancer Res Clin Oncol 108:351–353CrossRefPubMed
25.
go back to reference Kjeldsen SE, Eide I, Os I et al (1986) Serum phosphate and sympathetic tone in mild essential hypertension. Acta Med Scand Suppl 714:119–123 Kjeldsen SE, Eide I, Os I et al (1986) Serum phosphate and sympathetic tone in mild essential hypertension. Acta Med Scand Suppl 714:119–123
26.
go back to reference Lentz RD, Brown DM, Kjellstrand CM (1978) Treatment of severe hypophosphatemia. Ann Intern Med 89:941–944CrossRefPubMed Lentz RD, Brown DM, Kjellstrand CM (1978) Treatment of severe hypophosphatemia. Ann Intern Med 89:941–944CrossRefPubMed
27.
go back to reference Alsumrain MH, Jawad SA, Imran NB et al (2010) Association of hypophosphatemia with failure-to-wean from mechanical ventilation. Ann Clin Lab Sci 40:144–148PubMed Alsumrain MH, Jawad SA, Imran NB et al (2010) Association of hypophosphatemia with failure-to-wean from mechanical ventilation. Ann Clin Lab Sci 40:144–148PubMed
28.
go back to reference Kraft MD, Btaiche IF, Sacks GS et al (2005) Treatment of electrolyte disorders in adult patients in the intensive care unit. Am J Health Syst Pharm 62:1663–1682CrossRefPubMed Kraft MD, Btaiche IF, Sacks GS et al (2005) Treatment of electrolyte disorders in adult patients in the intensive care unit. Am J Health Syst Pharm 62:1663–1682CrossRefPubMed
29.
go back to reference Subramanian R, Khardori R (2000) Severe hypophosphatemia. Pathophysiologic implications, clinical presentations, and treatment. Medicine (Baltimore) 79:1–8CrossRef Subramanian R, Khardori R (2000) Severe hypophosphatemia. Pathophysiologic implications, clinical presentations, and treatment. Medicine (Baltimore) 79:1–8CrossRef
Metadata
Title
Incidence of hypophosphatemia in advanced cancer patients: a recent report from a single institution
Authors
Taichi Yoshida
Daiki Taguchi
Koji Fukuda
Kazuhiro Shimazu
Masahiro Inoue
Katsunori Murata
Hiroyuki Shibata
Publication date
01-04-2017
Publisher
Springer Japan
Published in
International Journal of Clinical Oncology / Issue 2/2017
Print ISSN: 1341-9625
Electronic ISSN: 1437-7772
DOI
https://doi.org/10.1007/s10147-016-1063-0

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