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Pamidronate for Cancer-Associated Hypercalcemia-Reply

Rasim Gucalp, MD; Robert Knight, MD
Arch Intern Med. 1995;155(6):642-645. doi:10.1001/archinte.1995.00430060105016.
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In reply  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 studies1-4 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 studies5,6 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 others1,2 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

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