Expert opinion on the metabolic complications of mTOR inhibitors |
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| Affiliation: | 1. Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, MI, USA;2. Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA;3. Department of Family Medicine, University of Michigan Medical School, Ann Arbor, MI, USA;4. Department of Pathology, University of Michigan Medical School, Ann Arbor, MI, USA;5. MD Anderson Cancer Center, Houston, TX, USA;6. Nutritional Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA;7. Department of Biological Chemistry, University of Michigan Medical School, Ann Arbor, MI, USA;8. Department of Pharmacology, University of Michigan Medical School, Ann Arbor, MI, USA;1. Division of Health Care Research, Center for Public Health Sciences, National Cancer Center Japan, Tokyo, Japan;2. Department of Public Health, Faculty of Medicine, University of Toyama, Toyama, Japan;3. Department of Degenerative Neurological Diseases, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan;4. Department of Breast Surgery, National Cancer Center Hospital, Tokyo, Japan;5. Next Generation Science Institute, Morinaga Milk Industry Co. Ltd., Zama, Kanagawa, Japan;6. Division of Cancer Pathophysiology, National Cancer Center Research Institute, Tokyo, Japan;1. State Key Laboratory of Food Science and Technology, School of Food Science and Technology, Jiangnan University, Wuxi, 214122, People''s Republic of China;2. Synergistic Innovation Center for Food Safety and Nutrition, School of Food Science and technology, Jiangnan University, 1800 Lihu Rd, Wuxi 214122, Jiangsu, People''s Republic of China;3. School of Medicine, Jiangnan University, Wuxi, 214122, People''s Republic of China |
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| Abstract: | 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 HbA1C 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 HbA1C 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 > 5 g/l resisting dietary measures adapted to oncologic status. In non-controllable hypertriglyceridemia exceeding 10 g/l, mTORi treatment should be interrupted and specialist opinion should be sought. |
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| Keywords: | Diabetes Dyslipidemia mTOR inhibitors Diabète Dyslipidémie Inhibiteurs mTOR |
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