Meta-analysis of incidence and risk of hypomagnesemia with cetuximab for advanced cancer.

BACKGROUND: Cetuximab is often used in patients with colorectal cancer, head and neck cancer, and other cancers. Hypomagnesemia is a major adverse event that was often ignored in studies. The aim of this meta-analysis is to gain a better understanding of the overall incidence and risk of hypomagnesemia in patients who received cetuximab-based therapy.
METHODS: Databases, including Pubmed, EMBASE, The Cochrane Library, American Society of Clinical Oncology (2000-2008), and Web of Science, were searched to identify relevant studies. Eligible studies were prospective phase II/III clinical trials of patients with cancer assigned cetuximab at a dose of 400 mg/m(2) i.v. on day 1 and 250 mg/m(2) weekly thereafter. The primary endpoint was incidence of hypomagnesemia.
RESULTS: Nineteen clinical reports were identified which included a total of 4,559 patients available for analysis, with 3,081 patients assigned cetuximab-based treatment. This result showed a high incidence of grade 3 and 4 hypomagnesemia (5.6%; 95% CI = 3.0-10.2) and a high incidence of all-grade hypomagnesemia associated with cetuximab-based therapy for advanced cancer (36.7%; 95% CI = 22-54.4). Compared with non-cetuximab therapy, cetuximab-based therapy has a higher risk of grade 3 and 4 hypomagnesemia (4.75; 95% CI = 3.661-6.18) and all-grade hypomagnesemia (4.75; 95% CI = 3.661-6.18).
CONCLUSION: Cetuximab-based therapy is associated with a significant risk of hypomagnesemia. Early monitoring and effective management of hypomagnesemia are important for patients that received cetuximab-based therapy.