title: Efficacy of everolimus in patients with metastatic insulinoma and refractory hypoglycemia.
abstract: 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 1-35+ months), median time to the first recurrence of symptomatic hypoglycemia was 6.5 months (range 0 to 35+ 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.
  
  
  CONCLUSIONS
  Everolimus appears to be a new effective treatment for patients with metastatic insulinoma and refractory hypoglycemia. Tolerance should be carefully monitored.
authors: Department of Nuclear Medicine and Endocrine Oncology, Gustave Roussy Institute, University Paris Sud-XI, Villejuif, France.
authors: Valérie
authors: V
authors: Bernard
authors: Catherine
authors: C
authors: Lombard-Bohas
authors: Marie-Caroline
authors: MC
authors: Taquet
authors: François-Xavier
authors: FX
authors: Caroli-Bosc
authors: Philippe
authors: P
authors: Ruszniewski
authors: Patricia
authors: P
authors: Niccoli
authors: Rosine
authors: R
authors: Guimbaud
authors: Cécile N
authors: CN
authors: Chougnet
authors: Bernard
authors: B
authors: Goichot
authors: Vincent
authors: V
authors: Rohmer
authors: Françoise
authors: F
authors: Borson-Chazot
authors: Eric
authors: E
authors: Baudin
mesh_terms: D000328:Adult; D000368:Aged; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D000068338:Everolimus; D005260:Female; D006801:Humans; D007003:Hypoglycemia / Q000188:drug therapy* / Q000209:etiology; D007340:Insulinoma / Q000150:complications / Q000188:drug therapy* / Q000556:secondary; D008113:Liver Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000556:secondary; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000150:complications / Q000188:drug therapy* / Q000473:pathology; D012189:Retrospective Studies; D020123:Sirolimus / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D000970:Antineoplastic Agents; D000068338:Everolimus; D020123:Sirolimus