Everolimu Resolving Hypoglycemia, Producing Hyperglycemia, and Necessitating Insulin Use in A Patient With Di Etes and Nonresectable Malignant Insulinoma

Ferrer-García, Juan Carlos; Tolosa-Torréns, Mercedes; Hernando-Meliá, Cristina; Arribas-Palomar, Luis; Sánchez-Juan, Carlos

doi:10.4158/ep10282.cr

Cited by 18 publications

(13 citation statements)

References 6 publications

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“…Data on everolimus in the control of hypoglycemic symptoms have been recently published (20,21,22,23). Our study confirms these data, with the largest number of patients ever reported in the literature and a significant duration of follow-up.…”

Section: Discussionsupporting

confidence: 88%

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Efficacy of everolimus in patients with metastatic insulinoma and refractory hypoglycemia

Bernard

Lombard‐Bohas

Taquet

et al. 2013

European Journal of Endocrinology

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Background: Refractory hypoglycemia in patients with metastatic insulinoma is an important cause of morbidity and mortality. Everolimus could be a new therapeutic option. Methods: Within the French Group, we conducted a retrospective, multicentric study of endocrine tumors to evaluate the time to the first recurrence of symptomatic hypoglycemia, after everolimus initiation, in patients with metastatic insulinoma and refractory hypoglycemia. Ongoing hyperglycemic medical options, tumor response, and safety information were recorded. Results: Twelve patients with metastatic insulinoma and refractory hypoglycemia who were treated with everolimus between May 2007 and June 2011 were reviewed. Everolimus (starting dose, 10 mg/day, except in one patient, 5 mg/day) was given after a median of four previous therapeutic lines. Medication aimed at normalizing blood glucose levels in 11 patients. After a median duration of 6.5 months (range 1-35C months), median time to the first recurrence of symptomatic hypoglycemia was 6.5 months (range 0 to 35C months). Three patients discontinued everolimus because of cardiac and/or pulmonary adverse events at 1, 1.5, and 7 months after initiation, which led to two deaths. Three patients discontinued everolimus because of tumor progression at 2, 3, and 10 months after initiation, without recurrence of hypoglycemia. Conclusion: Everolimus appears to be a new effective treatment for patients with metastatic insulinoma and refractory hypoglycemia. Tolerance should be carefully monitored.

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Section: Discussionsupporting

confidence: 88%

“…In two of four patients, partial responses were observed at 16 and 29 months. Four other case reports mentioned successful efficacy of mTOR inhibitors in controlling hypoglycemia (11,21,22,23), although failure to control hypoglycemic symptoms was reported in one case (24).…”

Section: Introductionmentioning

confidence: 99%

Efficacy of everolimus in patients with metastatic insulinoma and refractory hypoglycemia

Bernard

Lombard‐Bohas

Taquet

et al. 2013

European Journal of Endocrinology

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“…32 There have been no other clinical studies but the effectiveness of everolimus in preventing hypoglycemia in patients with insulinoma was confirmed in many case reports. [33][34][35][36][37][38][39][40][41] They are summarized in Table 2.…”

Section: Everolimusmentioning

confidence: 99%

“…[32][33][34][35][36]39 Several possible mechanisms of everolimus hyperglycemic activity have been proposed. Everolimus may reduce production and secretion of insulin 33 due to mToR inhibition downstream of insulin receptors 36 as well as through mToRC2 and alteration of Akt signaling.…”

Section: Everolimusmentioning

confidence: 99%

Glycemic control in patients with insulinoma

Matej¹,

Bujwid²,

Wroński³

2017

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Insulinoma is the most common neuroendocrine tumor of the pancreas. surgical management of insulinomas is considered to be the only curative method. however, effective glycemic control preoperatively and in unresectable insulinomas remains a significant issue. hyperinsulinism, occurring as a result of the hormone-secreting tumor, leads to life-threatening hypoglycemia episodes which require urgent medical treatment. This article discusses current management of hypoglycemia in insulinoma patients, including: education and lifestyle modifications, pharmacotherapy (diazoxide, somatostatin analogs, mTor inhibitor -everolimus), cytoreductive methods and continuous glucose monitoring systems.

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“…Hipoglisemi kontrolünde Diazoksid, beta blokerler, difenilhidantoin, somatostatin analogları ve everolimus kullanılabilmektedir (13,14,15). Diazoksid ATP duyarlı potasyum kanallarını açarak insü-linoma hücrelerinden insülin salınımını inhibe eder.…”

Section: Resim 1: Pankreas Başında Kitleunclassified