Title: The Action of Manual Making and Team Approach for Using Denosumab in the Bone Metastasis Case
Abstract: Background: We can use denosumab which is an anti-RANKL antibody for bone metastasis, and the improvement of the patient's QOL is expected by the efficacy and convenience of denosumab. On the other hand, the side effect of severe hypocalcemia requires care in the case of administration of denosumab. In Japan, it is reported 32 cases of the side effect of severe hypocalcemia at a point of September 2012, however the evidence about the prevention and treatment of side effects is restrictive. PurposeWe make a treatment manual of denosumab, and a medical worker has common knowledge to be able to do the appropriate prevention and treatment for the severe hypocalcemia and the osteonecrosis of the jaw. ActionIn our hospital, we performed the treatment of denosumab for 41 patients with bone metastasis by March 2013. It had revision of precautions for use of denosumab at September 2012 and we started a project team which consisted of the many types of job in our hospital. We reviewed about recruitment methods of monitoring stage and frequency of serum calcium level and adequate use if calcium and vitamin D to prevent the severe hypocalcemia. Based on this review, we mede a treatment manual of denosumab. We give a presentation about project team start mainly on an action of manual making and measures to hypocalcemia.