Denosumab in the treatment of hypercalcemia secondary to malignancy

Hypercalcemia secondary to malignancy is associated with serious morbidity and mortality. Current treatment paradigms focus on acute lowering of serum calcium with a combination of intravenous volume repletion and expansion coupled with therapies to decrease bone release of calcium (calcitonin, bisphosphonates). While highly effective, in some cases, patients may be refractory to these existing therapies or may not tolerate them. Recently, the role of receptor activator of nuclear factor-KB ligand in bone modeling has been elucidated and specific therapies to target this pathway have been developed. One of these therapies, denosumab has been effectively used in the management of postmenopausal osteoporosis. Given the important role of bone modeling in the development of malignancy associated hypercalcemia, denosumab has been used to treat this condition. This review focuses on the existing clinical data regarding denosumab for the treatment of hypercalcemia of malignancy. Keywords: denosumab, hypercalcemia, malignancy, therapy