This protocol applies to patients with severe or symptomatic hypercalcaemia in inoperable or persistent parathyroid carcinoma, specifically when the first-line approach to calcium control has not achieved adequate serum calcium reduction.
The patient has inoperable or persistent parathyroid carcinoma presenting with severe or symptomatic hypercalcaemia. Medical management of hypercalcaemia is the main treatment for patients awaiting surgery and those with inoperable disease, with intravenous saline hydration and bisphosphonate administration as the cornerstones of initial care.
The first-line regimen — cinacalcet, intravenous saline hydration, and zoledronic acid — did not achieve the goal of adequate reduction and sustained control of serum calcium. This unmet target is the indication for escalation to this next-line protocol.
The objective of this protocol is control of resistant hypercalcaemia through reduction of serum calcium. The approach involves a targeted agent used specifically for hypercalcaemia that has not responded to initial measures. The complete regimen is available in the full protocol below.
DOI: 10.1016/j.esmoop.2024.103664
Medical management of hypercalcaemia is the main treatment for patients awaiting surgery and those with inoperable PC.
The cornerstones of treatment for severe or symptomatic hypercalcaemia are intravenous saline hydration and bisphosphonate administration.
Denosumab is recommended in patients with resistant hypercalcaemia [III, A; FDA approved, not EMA approved].
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