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Rasim Gucalp, MD
Bronx, NY

Robert Knight, MD
Summit, NJ

Arch Intern Med. 1995;155(6):642-645.

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Anand and Anand raised some interesting questions about the treatment of cancer-associated hypercalcemia. The role of parathyroid hormone—related protein (PTHrP) in cancer-associated hypercalcemia is the focus of intense research. Many studies^1-4 suggest that increased PTHrP levels negatively influence the response of hypercalcemia to bisphosphonates. Walls et al⁴ reported that circulating PTHrP significantly reduced the effectiveness of pamidronate in patients with no bone metastases. However, in two randomized, prospective, double-blind studies^5,6 of cancer-associated hypercalcemia, we demonstrated that the efficacy of pamidronate therapy was similar in patients with and without bone metastases. Some studies³ have shown a positive correlation between increased PTHrP concentrations and corrected serum calcium levels, but others^1,2 have not confirmed this. Many different PTHrP detection methods are currently in use.^7,8 This makes it difficult to compare the relative role of PTHrP in published studies. Additionally, the prediction of a poor response . . . [Full Text PDF of this Article]

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