Older Treatments

Older treatments like mithramycin and calcitonin have recently been replaced with newer management strategies, mostly involving bisphosphonates. Emerging therapeutic approaches include monoclonal antibodies to parathyroid hormone related peptide (PTH-rP), inhibition of RANK ligand through the use of a soluble form of its receptor osteoprotegerin, analogues of vitamin D and selective inhibition of the Ras-Raf-MAPK-ERK signalling pathway [15].

Calcitonin

The value is questionable because the reductions are small (approximately 1.0 mg/dl [0.25 mmol/L]) and transient [10].

Mithramycin

This was the mainstay of therapy for hypercalcaemia associated with cancer before the bisphosphonates became available. It remains effective, but its use is limited by potential adverse effects [10].

Gallium nitrate

Use is now limited as administration must be continuous and is laborious and less effective than previously thought.

Furosemide has been used in a fluid overloaded patient but not recommended due to potential complications and availability of drugs which inhibit bone resorption.’ ³