Hypercalcemia and cancer: Gallium was more effective than calcitonin

Clinical bottom line (level 1b)

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

The study

Double-blinded unconcealed randomised trial with intention-to-treat
Setting: University Hospital USA

50 patients (aged mean 55.5, 54% male) hypercalcaemia > or = 3.0 mmol/l due to cancer.

Excluded if
  • serum creatinine > 221 mmol/dl
  • cytotoxic chemotherapy, mithramycin or radiation within 7 days
  • concomitant aminoglycoside therapy
  • life expectancy < 4 weeks or no reasonable expectation of benefit
  • malignant lymphoma


    • Note:
  • All patients had iv rehydration +- frusemide for at least 2 days before entry into study. Patients were stratified for histology.


    • Control Group: (n = 26, 26 analysed): salmon calcitonin 8 IU/kg every 6 hours for 5 days by intramuscular injection
    Experimental Group: (n = 24, 24 analysed): gallium nitrate 200 mg/m ² in 11.5% dextrose daily and placebo

    100% followed for 7 days

    The evidence

    Outcome Time to outcome CEREERRRR
    (95% CI)    		ARR
    (95% CI)    		NNT
    (95% CI)
    Normocalcaemic 7 days 8
    (30.8%)    		 18
    (75.0%)    		 64%
    (24% to 83%)    		 44.2%
    (19.4% to 69.0%)    		 2
    (1 to 5)

    Citation

    1. Warrell RP, Israel R, Frisone M, et al: Gallium nitrate for acute treatment of cancer-related hypercalcemia. Annals of Internal Medicine 1988; 108: 669-674
    Search Terms: Hypercalc* AND gallium in Cochrane
    Contributor: Dr Chris Ball and Musab Hayatli, January 1999
    Reviewer:

    Clinical Question.
    Patient malignant hypercalcaemia
    Intervention or Exposure gallium nitrate
    Comparison calcitonin
    Outcome normocalcaemia