Identifying optimal magnesium replenishment points based on risk of severe hypomagnesemia in colorectal cancer patients
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ORIGINAL ARTICLE
Identifying optimal magnesium replenishment points based on risk of severe hypomagnesemia in colorectal cancer patients treated with cetuximab or panitumumab Michio Kimura1 · Eiseki Usami1 · Hitomi Teramachi2 · Tomoaki Yoshimura1 Received: 15 June 2020 / Accepted: 8 August 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose Cetuximab and panitumumab are monoclonal antibodies that target the epidermal growth factor receptor (EGFR). Treatment with cetuximab and panitumumab commonly causes hypomagnesemia, and optimal management of this adverse effect remains unclear. Here, we evaluated the optimal magnesium replacement points based on the risk of severe hypomagnesemia in colorectal cancer patients who received cetuximab or panitumumab. Methods We retrospectively evaluated 184 patients who received cetuximab or panitumumab for colorectal cancer at Ogaki Municipal Hospital (Ogaki, Japan) between January 2010 and December 2019. Univariate analyses were conducted to evaluate the relationship between patient baseline characteristics and development of hypomagnesemia following cetuximab or panitumumab treatment. Variables that were significantly associated with hypomagnesemia in the univariate analyses as well as previously reported risk factors were entered into a multivariate logistic regression model. Results The incidence of hypomagnesemia was associated with panitumumab treatment, pre-replenishment serum magnesium concentration, treatment duration, and treatment line. Severe hypomagnesemia post-cetuximab or panitumumab treatment was significantly associated with low baseline magnesium concentrations ( 44.8 × 104/mm3
Odds ratio
95% confidence interval
p value
2.130
1.160–3.910
0.015*
3.190
0.670–15.200
0.145
0.561
0.306–1.030
0.061
1.560
0.300–8.080
0.598
3.270
1.170–9.150
0.024*
2.270
1.230–4.160
0.008*
2.790
1.480–5.260
0.001*
1.300
0.984–1.710
0.065
1.060
0.673–1.670
0.789
0.765
0.343–1.710
0.513
1.000
0.993–1.020
0.438
1.010
0.989–1.030
0.428
1.480
0.557–3.939
0.431
1.880
1.000–3.520
0.050
1.000
1.000–1.000
0.408
1.010
0.985–1.040
0.388
EGFR epidermal growth factor receptor * 50 years Sex Male Serum creatinine > 0.6 mg/dL Serum magnesium 197 days Treatment line > 3 lines Chemotherapy Concomitant platinum chemotherapy
Odds ratio
95% confidence interval
p value
2.350
1.190–4.680
0.015*
1.800
0.345–9.430
0.484
0.693
0.337–1.420
0.318
2.070
0.579–7.420
0.263
4.590
1.320–16.000
0.017*
3.260
1.600–6.610
0.001*
1.750
1.220–2.550
0.002*
1.210
0.881–1.680
0.235
EGFR epidermal growth factor receptor
Table 5 Multivariate logistic regression analysis of risk factors for anti-EGFR treatment-related severe hypomagnesemia (grade 3–4)
2.0 1.8
Grade0
Odds ratio 95% confidence interval
1.6 1.4
Grade1
1.2 1.0
Grade4
0.6
Grade3
0.8
Grade2
Highest serum magnesium concentration during magnesium supplementation (mg/dL)
* 4 lines 0.078 Serum magnesium level at the start of supplementati
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