Abstract
Background
Despite occurring in 30% of patients, there are no evidence-based guidelines on the
management of epidermal growth factor receptor inhibitor (EGFRI)-induced hypomagnesemia.
Based on expert opinion, severe hypomagnesemia should be treated by intravenous magnesium
replacement. A systematic review of published data of intervention on EGFRI-induced
hypomagnesemia was performed.
Methods
Articles from 1960 to March 2015 were identified from Medline, Embase, Cochrane Central
Register of Controlled Trials, and PubMed using a peer-reviewed systematic search
strategy. Eligible studies included randomized controlled trials or observational
studies that evaluated management of hypomagnesemia in adult patients treated with
EGFRIs. Risk factors for severe hypomagnesemia were also assessed. The quality of
included studies was rated using Jadad scores.
Results
A total of 1327 references were identified, and 6 studies, involving 486 patients,
met inclusion criteria for analysis. There were no randomized controlled trials, and
all included studies were of poor quality. From the studies included in this review,
severity of EGFRI-induced hypomagnesemia was associated with length of EGFRI treatment,
concomitant platinum chemotherapy, increasing age, and baseline magnesium concentration.
In most patients with grade 3 or 4 hypomagnesemia, high-dose intravenous magnesium
replacement did not achieve sustainable magnesium repletion beyond 72 hours. Oral
magnesium supplementation was not effective or tolerable. Severe hypomagnesemia has
been associated with tachycardia and mental alteration. After discontinuation of EGFRI
therapy, hypomagnesemia generally resolves within weeks to months.
Conclusions
There is an absence of high-quality evidence for the management of EGFRI-induced hypomagnesemia.
As hypomagnesemia is often refractory to frequent intravenous or oral replacement,
there is a need for prospective trials of new interventions for this common toxicity.
Keywords
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Article info
Publication history
Published online: February 12, 2016
Accepted:
February 3,
2016
Received in revised form:
December 21,
2015
Received:
September 3,
2015
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
