Service d'endocrinologie, diabétologie, maladies métaboliques, CHU de Dijon, 2, boulevard du Maréchal-de-Lattre, BP 77908, 21000 Dijon, France; Unité Inserm, LNC-UMR 1231, université de Bourgogne, Dijon, France.
Service d'endocrinologie, diabétologie, maladies métaboliques, CHU de Dijon, 2, boulevard du Maréchal-de-Lattre, BP 77908, 21000 Dijon, France.
Ann Endocrinol (Paris). 2018 Oct;79(5):583-590. doi: 10.1016/j.ando.2018.07.010. Epub 2018 Aug 23.
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.
在 III 期临床试验中，使用 mTOR 抑制剂（mTORi）作为抗癌药物导致高血糖（12-50%）和高血脂（7-73%）。这些高发生率需要对癌症患者进行适应性治疗。在开始 mTORi 治疗之前，应系统进行血脂谱筛查，非糖尿病患者进行空腹血糖检测，糖尿病患者进行 HbA 检测。开始后，应系统监测血脂谱，非糖尿病患者每月进行一次空腹血糖检测，第一个月每两周一次。已知糖尿病患者在开始治疗前后和 mTORi 下发生糖尿病时，HbA 目标值应≤8%。LDL-胆固醇目标值应根据一般健康状况、心血管和肿瘤预后进行调整。如果需要治疗，应首选普伐他汀；阿托伐他汀和辛伐他汀禁用。对于抵抗适应肿瘤状况的饮食措施的>5g/l 高甘油三酯血症，应开用非诺贝特。在无法控制的超过 10g/l 的高甘油三酯血症中，应中断 mTORi 治疗并征求专家意见。
