Hypercalcaemia: cancer: gallium nitrate was better than calcitonin.

Clinical bottom line (level 1b)

  1. Patients with hypercalcaemia due to malignancy who have gallium nitrate compared with calcitonin were more likely to become normocalcaemic (NNT = 2 at 7 days) .
Warrell et al: Annals of Internal Medicine 1988; 108 (5): 669-674
Expires October 2003

The study

Double-blinded concealed randomised trial with intention-to-treat
Setting: university hospital, USA

50 patients (aged ?, ?% male) admitted with hypercalcaemia (3.0 mmol/l or more) due to cancer (diagnosed on histology)

Excluded if
  • serum creatinine > 221 mmol/dl
  • cytotoxic chemotherapy, mithramycin or radiation within seven days
  • concomitant aminoglycoside therapy
  • life expectancy < 4 weeks or no reasonable expectation of benefit
  • malignant lymphoma


    • Control Group: (n = 26, 26 analysed): salmon calcitonin 8 IU/kg every six hours for five days and placebo
    Experimental Group: (n = 24, 24 analysed): gallium nitrate 200 mg/m ² in 1l 5% dextrose daily and placebo
    All patients had intravenous rehydration and furosemide for at least two days before entry into study. Patients were stratified for histology. No other hypoglycaemic medication was allowed.
    100% followed for 7 days

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    still hypercalcaemic 7 days 18
    (69.2%)    		 6
    (25.0%)    		 64%
    (24% to 83%)    		 44.2%
    (19.4% to 69.0%)    		 2
    (1 to 5)

    Comments

    1. Calcitonin has not been shown to be clearly better than placebo at treating hypercalcaemia caused by malignancy.

    Citation

    1. Warrell RP, Israel R, Frisone M, et al: gallium nitrate for acute treatment of cancer-related hypercalcemia: a randomized, double-blind comparison to calcitonin. Annals of Internal Medicine 1988; 108 (5): 669-674
    Search Terms: hypercalc* and gallium in Cochrane
    Contributor: Chris Ball and Clare Wotton, October 2000
    Reviewer:

    Clinical Question.
    Patient hypercalcaemia due to malignancy
    Intervention or Exposure gallium nitrate
    Comparison calcitonin
    Outcome normocalcaemia