Sunitinib
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Hypoglycaemic episodes: case report A 48-year-old woman developed severe hypoglycaemic episodes during treatment with sunitinib for pancreatic metastatic insulinoma. The woman, who had hypoglycaemic crisis, was diagnosed with pancreatic metastatic insulinoma in 2014. Due to expression of somatostatin receptor in liver and pancreatic lesions, she started receiving treatment with an unspecified somatostatin analogue. In August 2016, she had disease progression. Therefore, she was started on everolimus along with unspecified somatostatin analogue resulted in insulinoma syndrome control and disease stabilization for two years. However, in March 2018, radiographic findings showed disease progression to the liver. Therefore, her everolimus was switched to sunitinib [dosage and route not stated] maintaining previous therapy with somatostatin analogue. Few weeks after sunitinib initiation, she developed episodes of severe hypoglycaemia with dramatic worsening of her insulinoma syndrome [duration of treatment to reaction onset not clearly stated]. The woman was treated with glucose infusions and diazoxide with insufficient glycaemic control. Her sunitinib therapy was immediately discontinued, and supportive care was given with poor glycaemic control. Therefore, she was reinitiated on everolimus in April 2018 and blood glucose level normalised within 3 weeks. Her diazoxide and glucose therapy was withdrawn. Thereafter, temozolomide was added to the chemotherapy regimen. She well-tolerated the chemotherapy with optimum glycaemic control and disease stabilisation lasting 5 months. In October 2018, she showed further disease progression. Therefore, she received two cycles of FOLFOX regimen comprising folinic acid, fluorouracil and oxaliplatin with partial response and improved blood glucose levels. In December 2018, her everolimus was gradually discontinued and glucose level stabilised within normal range. Three months later, she developed spinal cord compression due to bone metastasis and died within a month [immediate cause of death not stated]. Tovazzi V, et al. Should everolimus be stopped after radiological progression in metastatic insulinoma? A "cons" point of view. Endocrine 69: 481-484, No. 3, Sep 2020. 803503874 Available from: URL: http://doi.org/10.1007/s12020-020-02368-4
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Reactions 26 Sep 2020 No. 1823
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