The Effects of Lu-177 on Calcium Levels
A man who recently had a Lu177 treatment and is taking Xgeva and Zytiga has been experiencing severe serum (blood) calcium loss. Why might this be happening, and what should he do?
Xgeva is used to build and maintain bone mineral density. It does this by using serum calcium to maintain bone mineral density. So, low calcium levels might handicap the Xgeva.
PSMA-617 (the ligand used with Lu-177), like other chelating agents (like gadolinium contrast agent used with MRIs), it can bind to the serum calcium so that it cannot be utilized to maintain or build bone. In cases where an agent like Lu-177 is used, calcium levels must be actively monitored, and Calcium and Vitamin D supplementation is essential.
In cases where oral supplementation does not resolve the low serum (blood), calcium levels calcium should be delivered by infusions.
It is also a good idea to have this man’s blood checked for blood pH, parathyroid functioning, Vitamin D, calcitonin, magnesium, phosphate, citrate, creatinine, and albumin on a regular schedule.
