title: [Management of metabolic disorders induced by everolimus in patients with differentiated neuroendocrine tumors: expert proposals].
abstract: Medical management of pancreatic neuroendocrine tumors has recently been improved by new molecules of which the mTOR inhibitor everolimus. If digestive neuroendocrine tumors are rare, the incidence is in constant increase and the prevalence in digestive cancers put them right behind colorectal cancers. Everolimus has demonstrated efficacy in unresectable and progressive pancreatic neuroendocrine tumors, by doubling the median progression free survival (11 versus 4.6 months), with a median time of exposure to everolimus of nine months. Everolimus is generally maintained until progression or intolerance and some patients are treated during several years. Potential metabolic disorders induced by everolimus (dyslipidemia, hyperglycemia) in patients with life expectancy of several years, justify monitoring of these parameters and accurate treatment management algorithm. These will avoid worsening patient's prognostic, but also prematurely discontinue potentially effective treatment or contraindicate other therapeutic weapons, in a pathology in which there are multiple therapeutic options in metastatic phase. We propose a standard practice in terms of initial assessment, monitoring, care threshold, and therapeutic objectives to manage metabolic disorders, fitted to our patients with advanced pancreatic neuroendocrine tumors.
authors.affiliation: Hospices civils de Lyon, Pavillon H, hôpital E-Herriot, service d'oncologie médicale, place d'Arsonval, 69437 Lyon cedex 03, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Lombard-Bohas
authors.affiliation: CHU Nantes, clinique d'endocrinologie, 44093 Nantes cedex 1, France.
authors.forename: Bertrand
authors.initials: B
authors.lastname: Cariou
authors.affiliation: CHU de Dijon, hôpital du Bocage, service endocrinologie, diabétologie, 14, rue Paul-Gaffarel, 21000 Dijon, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Vergès
authors.affiliation: Hôpital Cochin, service de gastroentérologie, 27, rue du Faubourg-Saint-Jacques, 75014 Paris, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Coriat
authors.affiliation: CHRU, hôpital Jean Minjoz, service d'Oncologie, 2, boulevard Fleming, 25030 Besançon, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: N'guyen
authors.affiliation: Centre Antoine Lacassagne, 33, avenue Valombrose, 06189 Nice, France.
authors.forename: Eric
authors.initials: E
authors.lastname: François
authors.affiliation: Hôpital Beaujon, service de gastroentérologie-pancréatologie (PMAD), 100, boulevard du Général-Leclerc, 92118 Clichy, France.
authors.forename: Pascal
authors.initials: P
authors.lastname: Hammel
authors.affiliation: CHU de La Timone, 254, rue Saint-Pierre, 13385 Marseille cedex, France.
authors.forename: Patricia
authors.initials: P
authors.lastname: Niccoli
authors.affiliation: Hôpital Beaujon, service de gastroentérologie-pancréatologie (PMAD), 100, boulevard du Général-Leclerc, 92118 Clichy, France.
authors.forename: Olivia
authors.initials: O
authors.lastname: Hentic
mesh_terms: D050171:Dyslipidemias / Q000139:chemically induced*; D000068338:Everolimus; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced*; D018358:Neuroendocrine Tumors / Q000188:drug therapy* / Q000473:pathology; D010190:Pancreatic Neoplasms / Q000188:drug therapy* / Q000473:pathology; D020123:Sirolimus / Q000009:adverse effects / Q000031:analogs & derivatives*
chemical_list: D000068338:Everolimus; D020123:Sirolimus
keywords: dyslipidemia; everolimus; hyperglycemia; mTOR inhibitor; metabolic disorders; neuroendocrine tumors
vernacular_title: Prise en charge des troubles métaboliques observés avec évérolimus chez les patients atteints de tumeurs neuroendocrines bien différenciées non résécables : propositions d'experts.