Tyrrell Helen Elizabeth Jane, Pwint Thinn
Department of Oncology, Buckinghamshire NHS Trust, Aylesbury, Buckinghamshire, UK.
BMJ Case Rep. 2014 Dec 24;2014:bcr2014207521. doi: 10.1136/bcr-2014-207521.
There is increasing use of tyrosine kinase inhibitors as targeted therapy for several malignancies. Sunitinib is the first-line treatment for renal cancer and we report a case of a man receiving this medication who also had diabetes. When started on sunitinib he experienced improvement in his diabetes control with reduction in his insulin requirements, which later worsened when sunitinib was reduced or stopped. Several retrospective studies have been performed demonstrating this effect with sunitinib, but to date no prospective studies have been reported. Most tyrosine kinase inhibitors reduce blood glucose levels in diabetics, but some agents, such as nilotinib, may increase them. There is no consensus on the mechanism of action of sunitinib in reducing glucose levels. Several theories have been postulated, such as increased insulin secretion, increased insulin sensitivity, reduced loss of islet cells, the gastrointestinal side effects of sunitinib, or an interaction with other antihyperglycaemic agents.
酪氨酸激酶抑制剂作为多种恶性肿瘤的靶向治疗药物，其使用越来越广泛。舒尼替尼是肾癌的一线治疗药物，我们报告了一例正在接受该药物治疗的男性患者，他同时患有糖尿病。开始使用舒尼替尼时，他的糖尿病控制情况有所改善，胰岛素需求量减少，但后来当舒尼替尼减量或停药时，情况又恶化了。已经进行了多项回顾性研究，证实了舒尼替尼的这种作用，但迄今为止尚未有前瞻性研究报告。大多数酪氨酸激酶抑制剂可降低糖尿病患者的血糖水平，但有些药物，如尼罗替尼，可能会升高血糖。关于舒尼替尼降低血糖水平的作用机制尚无共识。已经提出了几种理论，如胰岛素分泌增加、胰岛素敏感性增加、胰岛细胞损失减少、舒尼替尼的胃肠道副作用或与其他降糖药物的相互作用。
