Paclitaxel-Induced Hypocalcemia in a Patient with Metastatic Breast Disease and Underlying Hypoparathyroidism
https://doi.org/10.15605/jafes.041.S1
- Author:
Marina Norman
1
;
Nur Aini Eddy Warman
1
;
Nur Haziqah Baharum
1
;
Aimi Fadilah Mohamad
1
;
Mohd Hazriq Awang
1
;
Fatimah Zaherah Mohamed Shah
1
;
Rohana Abdul Ghani
1
Author Information
1. Department of Internal Medicine, Faculty of Medicine, Universiti Teknologi MARA
- Publication Type:Journal Article
- MeSH:
Hypocalcemia;
Hypoparathyroidism;
Breast Diseases;
Paclitaxel
- From:
Journal of the ASEAN Federation of Endocrine Societies
2026;41(S1):74-
- CountryPhilippines
- Language:English
-
Abstract:
Introduction:Hypocalcemia in patients with advanced malignancy is
usually attributed to bone metastases, vitamin D deficiency,
renal impairment, or antiresorptive therapy. Paclitaxel,
a taxane-based chemotherapy agent widely used for
breast cancer, is not commonly associated with calcium
disturbances. Proposed mechanism includes renal tubular
dysfunction, renal salt wasting, and disruptions in bone
metabolism. In patients with underlying disorders of
calcium homeostasis such as hypoparathyroidism, taxanebased chemotherapy such as Docetaxel and Paclitaxel
may exacerbate calcium imbalance. We reported a case of
recurrent hypocalcemia associated with paclitaxel therapy
in a patient with metastatic breast cancer.
Case:A 42-year-old female with metastatic breast cancer,
involving the liver and bones, had previously undergone
neoadjuvant chemotherapy, mastectomy, and adjuvant
radiotherapy. Following the disease progression, she was
commenced on weekly intravenous paclitaxel at a 20%
dose reduction due to prior complications and underlying
metabolic risk. She had a history of post-thyroidectomy
hypoparathyroidism and had previously been intolerant
to docetaxel during the neoadjuvant chemotherapy, which
was complicated by hypocalcemia, likely secondary to renal
salt wasting. During paclitaxel treatment, she developed recurrent
symptomatic hypocalcemia, requiring multiple hospital
admissions and repeated intravenous calcium gluconate
infusions despite ongoing oral calcium and calcitriol
supplementation, which were temporarily increased during the chemotherapy. These episodes occurred intermittently
in temporal association with paclitaxel administration, with
other causes of hypocalcemia were considered less likely.
Conclusion:Hypocalcemia associated with paclitaxel is rarely
described in literature. This case highlights the importance
of monitoring calcium level in patients receiving paclitaxel,
particularly in those with pre-existing hypoparathyroidism.
- Full text:2026080410533530658EP_A099.pdf
