Abstract
BackgroundLow-dose Cisplatin and Interferon alpha treatment of solid tumors rarely has been associated with severe hypocalcaemia. To the authors knowledge the phenomenon has not been reported previously in patients with pancreatic carcinoma.Case presentationA patient with resected adenocarcinoma of the pancreas was treated with adjuvant radio-chemo-immunotherapy using a combination of low-dose Cisplatin, 5-Fluorouracil and Interferon alpha together with external beam radiation. Severe hypocalcaemia without signs of acute renal failure or electrolyte disturbance occurred within 2 days at the 4th week of treatment and required intensive care treatment.ConclusionCombination of biological and cytotoxic therapies may increase the incidence of severe hypocalcaemia in pancreatic cancer. Oncologists should remain attentive of this problem as more highly active regimes become available.
Highlights
Low-dose Cisplatin and Interferon alpha treatment of solid tumors rarely has been associated with severe hypocalcaemia
Case presentation: A patient with resected adenocarcinoma of the pancreas was treated with adjuvant radio-chemo-immunotherapy using a combination of low-dose Cisplatin, 5-Fluorouracil and Interferon alpha together with external beam radiation
Combination of biological and cytotoxic therapies may increase the incidence of severe hypocalcaemia in pancreatic cancer
Summary
Hypocalcaemia is a known side-effect in high-dose Cisplatin chemotherapy of solid tumors [1,2]. Low-dose Cisplatin combined with biological Interferon-alpha therapy has previously not been associated with severe hypocalcaemia in patients with pancreatic cancer. Chemotherapy without Cisplatin and Interferon was started again according to cycle 2 and 3 of the CapRI schedule, over the following weeks of treatment the calcium levels remained within the normal range and the patient was asymptomatic. The consecutive analysis of 23 patients treated with the CapRI schedule of combined radio-chemo-immunothrapy revealed mild to severe hypocalcaemia and hypomagnesaemia in 65% of the patients despite calcium and magnesium supplementation. (Figure 1) The serum calcium levels of these patients reached values below the normal range at day 36 of treatment despite either oral or i.v. substitution started when the y were symptomatic with median levels of 2.04 mmol/l In all patients normal calcium levels were reached under i.v. and intensified oral therapy within 4 weeks of initial presentation
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