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Clinical relevance and utility of cetuximab-related changes in magnesium and calcium serum levels

Stintzing, Sebastiana; Fischhaber, Dorisa; Mook, Charlottea; Modest, Dominik P.a; Giessen, Clemensa; Schulz, Christopha; Haas, Michaela; Boeck, Stefana; Michl, Marliesa; Stemmler, Joachima; Laubender, Rüdiger P.b; Heinemann, Volkera

doi: 10.1097/CAD.0b013e32836411bc

Hypomagnesemia and hypocalcemia are common adverse events during cetuximab treatment. The influence of the chemotherapeutic combination on serum levels is unknown and the predictive value is currently under discussion. This analysis investigated 79 patients who had received cetuximab for at least 6 weeks in the day clinic of the Comprehensive Cancer Center, University of Munich. Calcium and magnesium serum levels were analyzed weekly; tumor response and adverse events were followed. Thirty-eight patients had metastatic colorectal cancer (mCRC) and the predictive value of hypomagnesemia was tested in these patients. During therapy, calcium serum levels decreased to about 97% of the baseline levels and were maintained for the duration of treatment. Magnesium levels showed a significant time-dependent decrease. Serum levels of magnesium were lower when cetuximab was combined with a platinum derivative. After a treatment duration of 12 weeks, magnesium levels decreased to 70% in platinum-treated patients, whereas they decreased to only 90% of baseline in patients who did not receive platinum therapy. In patients treated for mCRC, a decrease of serum magnesium below 95% of the baseline levels 14 days after initiating treatment separated patients significantly in terms of survival times. Magnesium levels decrease in a time-dependent manner during cetuximab therapy. As hypomagnesemia was more prominent in patients receiving platinum agents, magnesium measurements may be advised in these patients. In mCRC patients treated with cetuximab, day-14 magnesium serum levels correlated with treatment efficacy.

aDepartment of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern

bInstitute of Medical Informatics, Biometry and Epidemiology, University of Munich, Munich, Germany

Correspondence to Sebastian Stintzing, Department of Internal Medicine III and Comprehensive Cancer Center, Klinikum Grosshadern, University of Munich, Marchioninistrasse 15, 81377 Munich, Germany Tel: +49 89 7095 2208; fax: +49 89 7095 5256; e-mail:

Received March 12, 2013

Accepted June 10, 2013

© 2013 Wolters Kluwer Health | Lippincott Williams & Wilkins