Expert opinion on the metabolic complications of mTOR inhibitors.

Fiche publication

Date publication

août 2018

Journal

Annales d'endocrinologie

Auteurs

Membres identifiés du Cancéropôle Est :
Pr VERGES Bruno

Tous les auteurs :
Bouillet B, Buffier P, Smati S, Archambeaud F, Cariou B, Vergès B

Lien Pubmed

https://www.ncbi.nlm.nih.gov/pubmed/30144939

Résumé

Using mTOR inhibitors (mTORi) as anticancer drugs led to hyperglycemia (12-50%) and hyperlipidemia (7-73%) in phase-III trials. These high rates require adapted treatment in cancer patients. Before initiating mTORi treatment, lipid profile screening should be systematic, with fasting glucose assay in non-diabetic patients and HbA in diabetic patients. After initiation, lipid profile monitoring should be systematic, with fasting glucose assay in non-diabetic patients, every 2 weeks for the first month and then monthly. The HbA target is≤8%, before and after treatment initiation in known diabetic patients and in case of onset of diabetes under mTORi. LDL-cholesterol targets should be adapted to general health status and cardiovascular and oncologic prognosis. If treatment is indicated, pravastatin should be prescribed in first line; atorvastatin and simvastatin are contraindicated. Fenofibrate should be prescribed for hypertriglyceridemia>5g/l resisting dietary measures adapted to oncologic status. In non-controllable hypertriglyceridemia exceeding 10g/l, mTORi treatment should be interrupted and specialist opinion should be sought.