Journal of Cancer Research and Clinical Oncology

, Volume 120, Issue 10, pp 610–614 | Cite as

Hypercalcemia in patients with breast cancer: a survival study

  • S. de Wit
  • F. J. Cleton
Original Papers Clinical Oncology


In a retrospective study survival after hypercalcemia in breast cancer patients has been investigated. A group of 72 patients were treated with bisphosphonate APD [3-(amino-1,1-hydroxypropylidene)bisphosphonate] and third-generation amino-containing bisphosphonates between January 1980 and October 1992. A median survival of 4.5 months was found. In a multivariate analysis, four independent prognostic factors for survival have been found: the interval between first relapse and hypercalcemia, sites of metastases at the moment of hypercalcemia, primary treatment, and the level of serum alkaline phosphatase. Patients with a “flare” reaction on tamoxifen treatment and patients with a normal serum alkaline phosphatase level and bone metastases only had a prolonged survival. Hypercalcemia associated with visceral metastases carried a very poor prognosis. The level of serum calcium in this series of patients was no prognostic indicator for survival.

Key words

Hypercalcemia Breast cancer Bisphosphonates Tamoxifen Serum calcium APD 


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  1. Body JJ (1993) Medical treatment of tumor-induced hypercalcemia and tumor-induced osteolysis: challenges for future research. Supp Care Cancer 1:26–33Google Scholar
  2. Brada M, Rowley M, Grant DJ, Ashley S, Powles TJ (1990) Hypercalcemia in patients with disseminated breast cancer. Acta Oncol 29:577–580Google Scholar
  3. Cleton FJ (1988) Cancer in the Netherlands 1988. Kluwer, Dordrecht Boston LondonGoogle Scholar
  4. Coleman RE (1992) Bisphosphonates treatment of bone metastases and hypercalcemia of malignancy. Oncology 5:55–60Google Scholar
  5. Coleman RE, Rubens RD (1985) Bohe metastases and breast cancer. Cancer Treat Rev 12:251–270Google Scholar
  6. Coleman RE, Rubens RD (1987a) 3-(Amino-1,1-hydroxypropylidene)bisphosphonate (APD) for hypercalcaemia of breast cancer. Br J Cancer 56:465–469Google Scholar
  7. Coleman RE, Rubens RD (1987b) The clinical course of bone metastases from breast cancer. Br J Cancer 55:61–66Google Scholar
  8. Cox DR (1972) Regression models and life tables (with discussion). J R Statist Soc B34:187–220Google Scholar
  9. Grutters JC, Hermus ARMM, Mulder PHM de, Beex LVAM (1993) Long-term follow up of breast cancer patients treated for hypercalcaemia with aminohydroxypropylidene bisphosphonate (APD). Breast Cancer Res Treat 25:277–281Google Scholar
  10. Harinck HIJ, Bijvoet OLM, Plantingh AST, Body JJ, Elte JWF, Sleeboom HP, Wildiers J, Neijt JP (1987) Role of bone and kidney in tumour-induced hypercalcemia and its treatment with bisphosphonate and sodium chloride. Am J Med 82:1133–1142Google Scholar
  11. Imai K, Tomaru Y, Ohnuki T, Yamanaka H, Sakai H, Kanetake H, Minami Y, Nomata K, Saito Y (1992) Significance of a new stratification of alkaline phosphatase and extent of disease in patients with prostate carcinoma with bone metastasis. Cancer 69:2983–2989Google Scholar
  12. Kaplan EL, Meier P (1958) Nonparametic estimation from incomplete observations. J Am Statist Assoc 53:457–481Google Scholar
  13. Kristensen B, Ejlertsen B, Holmegaard SN, Kratup-Hansen A, Transbøl I, Mouridsen H (1992) Prednisolone in the treatment of severe malignant hypercalcaemia in metastatic breast cancer: a randomized study. J Intern Med 232:237–245Google Scholar
  14. Ralston SH, Dryburgh FJ, Cowan RA, Gardner MD, Jenkins AS, Boyle IT (1985) Comparison of aminohydroxypropylidene diphosphonate, mithramycin, and corticosteroids/calcitonin in treatment of cancer-associated hypercalcaemia. Lancet II:907–910Google Scholar
  15. Sleeboom HP, Bijvoet OLM, van Oosterom AT, Gleed JH, O'Riordan JLH (1983) Comparison of intravenous 3-(amino-1-hydroxypropylidene)-1,1-bisphosphonate and volume repletion in tumour-induced hypercalcaemia. Lancet II:239–243Google Scholar
  16. Van der Schueren E, Dongen JA van, Julien JP, Wildiers J (1991) Manual for clinical research in breast cancer, EORTC, p 68Google Scholar
  17. Van Holten-Verzantvoort ATM, Kroon HM, Bijvoet OLM, Cleton FJ, Beex LVAM, Blijham, G, Hermans J, Neijt JP, Papapoulos SE, Sleeboom HP, Vermey P, Zwinderman AH (1993) Palliative pamidronate treatment in patients with bone metastases from breast cancer. J Clin Oncol 11:491–498Google Scholar

Copyright information

© Springer-Verlag 1994

Authors and Affiliations

  • S. de Wit
    • 1
  • F. J. Cleton
    • 1
  1. 1.Department of Clinical OncologyUniversity Hospital LeidenLeidenThe Netherlands

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