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Identifying optimal magnesium replenishment points based on risk of severe hypomagnesemia in colorectal cancer patients treated with cetuximab or panitumumab

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Abstract

Purpose

Cetuximab and panitumumab are monoclonal antibodies that target the epidermal growth factor receptor (EGFR). Treatment with cetuximab and panitumumab commonly causes hypomagnesemia, and optimal management of this adverse effect remains unclear. Here, we evaluated the optimal magnesium replacement points based on the risk of severe hypomagnesemia in colorectal cancer patients who received cetuximab or panitumumab.

Methods

We retrospectively evaluated 184 patients who received cetuximab or panitumumab for colorectal cancer at Ogaki Municipal Hospital (Ogaki, Japan) between January 2010 and December 2019. Univariate analyses were conducted to evaluate the relationship between patient baseline characteristics and development of hypomagnesemia following cetuximab or panitumumab treatment. Variables that were significantly associated with hypomagnesemia in the univariate analyses as well as previously reported risk factors were entered into a multivariate logistic regression model.

Results

The incidence of hypomagnesemia was associated with panitumumab treatment, pre-replenishment serum magnesium concentration, treatment duration, and treatment line. Severe hypomagnesemia post-cetuximab or panitumumab treatment was significantly associated with low baseline magnesium concentrations (< 1.8 mg/dL; odds ratio 18.100, 95% confidence interval 1.570–210.000; p = 0.020) and low serum magnesium concentrations during treatment (< 1.1 mg/dL; odds ratio 93.800, 95% confidence interval 3.510–2510.000; p = 0.007).

Conclusion

To minimize the risk of severe hypomagnesemia during anti-EGFR treatment, magnesium replenishment should be initiated in patients with pre-replenishment concentrations of < 1.8 mg/dL, preferably before reaching intra-treatment concentrations of < 1.1 mg/dL.

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All relevant data are included in the manuscript and its associated files.

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Funding

No specific funding was obtained for this study.

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Authors and Affiliations

  1. Department of Pharmacy, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki-shi, Gifu, 503-8502, Japan

    Michio Kimura, Eiseki Usami & Tomoaki Yoshimura

  2. Laboratory of Clinical Pharmacy, Gifu Pharmaceutical University, Gifu-shi, Japan

    Hitomi Teramachi

Authors
  1. Michio Kimura
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  2. Eiseki Usami
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  3. Hitomi Teramachi
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  4. Tomoaki Yoshimura
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Contributions

MK contributed to the study design, collected, and provided the data, was the principal author of the report, and is the guarantor of the article and all data. EU, HT, and TY contributed to the study design, reviewed the article, and supervised drafting the report and the submission process. All authors approved the final version of the article.

Corresponding author

Correspondence to Michio Kimura.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethics approval

The study’s retrospective protocol was approved by the Institutional Review Board of Ogaki Municipal Hospital (20200528-3).

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Kimura, M., Usami, E., Teramachi, H. et al. Identifying optimal magnesium replenishment points based on risk of severe hypomagnesemia in colorectal cancer patients treated with cetuximab or panitumumab. Cancer Chemother Pharmacol 86, 383–391 (2020). https://doi.org/10.1007/s00280-020-04126-9

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  • DOI: https://doi.org/10.1007/s00280-020-04126-9

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