Denosumab is Effective for Controlling Serum Calcium Levels in Patients with Humoral Hypercalcemia of Malignancy Syndrome: A Case Report on Parathyroid Hormone-related Protein-producing Cholangiocarcinoma

Norihiro Ashihara; Koji Nakajima; Yoshiyuki Nakamura; Mutsuhiro Kobayashi; Kumiko Shirahata; Chika Maeda; Takeshi Uehara; Daisuke Gomi; Nobuo Ito

doi:10.2169/internalmedicine.55.7134

CASE REPORTS

Denosumab is Effective for Controlling Serum Calcium Levels in Patients with Humoral Hypercalcemia of Malignancy Syndrome: A Case Report on Parathyroid Hormone-related Protein-producing Cholangiocarcinoma

Norihiro Ashihara, Koji Nakajima, Yoshiyuki Nakamura, Mutsuhiro Kobayashi, Kumiko Shirahata, Chika Maeda, Takeshi Uehara, Daisuke Gomi, Nobuo Ito

Author information

Norihiro Ashihara
Department of Internal Medicine, Iida Municipal Hospital, Japan
Koji Nakajima
Department of Internal Medicine, Iida Municipal Hospital, Japan
Yoshiyuki Nakamura
Department of Internal Medicine, Iida Municipal Hospital, Japan
Mutsuhiro Kobayashi
Department of Internal Medicine, Iida Municipal Hospital, Japan
Kumiko Shirahata
Department of Internal Medicine, Iida Municipal Hospital, Japan
Chika Maeda
Department of Surgery, Iida Municipal Hospital, Japan
Takeshi Uehara
Department of Laboratory Medicine, Shinshu University School of Medicine, Japan
Daisuke Gomi
Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Japan
Nobuo Ito
Department of Pathology, Aizawa Hospital, Japan

Keywords: humoral hypercalcemia of malignancy (HHM), denosumab, anti-receptor activator of nuclear factor-kappaB ligand (RANKL) monoclonal antibody, cholangiocarcinoma

JOURNAL OPEN ACCESS

2016 Volume 55 Issue 23 Pages 3453-3457

DOI https://doi.org/10.2169/internalmedicine.55.7134

Details

Abstract

Hypercalcemia resulting in the elevation of serum parathyroid hormone-related protein (PTHrP) and suppression of serum PTH was observed in a patient with advanced cholangiocarcinoma (CCC) and multiple lymph node metastases. We confirmed humoral hypercalcemia of malignancy based on PTHrP-producing CCC. Chemotherapy with gemcitabine and cisplatin could not control the patient's serum PTHrP levels and the patient was affected with bisphosphonate-refractory hypercalcemia. We administered a single dose of denosumab, an anti-receptor activator of nuclear factor-kappaB ligand monoclonal antibody, and the patient's serum calcium levels remained close to the normal range for approximately 3 weeks without additional treatment.

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