Tumor-induced hypercalcemia. A review of the treatment by bisphosphonates

Introduction. - The incidence of tumor-induced hypercalcemia is between 10 to 20%. New treatments justify this review article. Current knowledge and key points. - Tumor-induced hypercalcemia (half of al l hypercalcemia) is divided into two groups: hematological tumors (10%), an d solid tumors (90%), with osteolytic hypercalcemia and humoral hypercalcem ia of malignancy (HHM. mediators include PTHrP). The two most common causes of tumor-induced hypercalcemia are lung cancer and breast cancer. Tumor-in duced hypercalcemia most commonly disturbs gastrointestinal, neurological, renal and cardiovascular functions. These symptoms may be erroneously attri buted to the underlying malignancy or its therapy. Prognosis of tumor-induc ed hypercalcemia is very poor, with median survival being about 3 months. B isphosphonates have emerged as the standard treatment of tumor-induced hype rcalcemia. The intravenous administration of isotonic saline is the first s tep in the management of tumor-induced hypercalcemia. Specific treatment of cancer remains essential to prevent TIH relapse. Future prospects and projects. - New bisphosphonates have appeared, the mos t potent known bisphosphonate today is zoledronate. (C) 2001 Editions scien tifiques et medicales Elsevier SAS.