Original article: Plicamycin and pamidronate in symptomatic tumor-related hypercalcemia: A prospective randomized crossover trial

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Abstract
We have conducted a randomized crossover comparative trial of a single-dose course of disodium (3-amino-1-hydroxypropylidene) bisphosphonate pentahydrate (pami-dronate) and plicamycin in 48 patients with a first occurrence of tumor-related hypercalcemia. All patients had hypercal-caemia-associated symptoms and serum-calcium levels (corrected for total protein) ⩾2.80 mmol/1. Pamidronate and plicamycin were given concurrently with rehydration immediately after diagnosis of hypercalcaemia was made. Both agents lowered serum calcium levels significantly within 1 week, with 88% of the evaluable patients in the pamidronate group and 45% of those in the plicamycin group achieving normocalcemia (p<0.01). In the patients who received pamidronate, the duration of normocalcemia was longer (p < 0.05) and there was a significant decrease in serum creatinine (p < 0.05). Vomiting occurred in 8 of 22 evaluable patients (36%) who received plicamycin, but in none of 25 evaluable patients who received pamidronate (P<0.01). Phlebitis occurred at the infusion site in more of the pami-dronate-treated patients (P <0.05). Hypocalcemia, which occurred in 8 of 25 evaluable patients (32%) in the pamidronate group and in 1 of 22 of those (5%) in the plicamycin group, was either clinically asymptomatic or mild, except in one pamidronate-treated patient. Overall, pamidronate was found to be more effective and better tolerated than plicamycin, thereby confirming results of previous studies that showed pamidronate to be an effective, simple, and safe agent for the relief of the morbidity associated with tumor-related bypercalcemia.