Endocrine Abstracts

Introduction: Therapeutic approach of patients (pts) with metastatic renal cell carcinoma (mRCC) may include the use of biological agents such as m-TOR inhibitors: temsirolimus (TM) and everolimus (EV). Its use is associated with metabolic dysfunction, especially with everolimus: hyperglycemia (37% TM treated pts vs 72% EV treated pts), hypercholesterolemia (25% TM treated pts vs 81% EV treated pts) and hypertriglyceridemia (30% TM treated pts vs 73% EV treated pts). Discontinuation of therapy is suggested, if grade 4 toxicity is observed: blood glucose>500 mg/dl, total cholesterol (TC)>500 mg/dl and triglycerides (TG)>10×UNL.

Objective and methods: Retrospective evaluation of lipid profile (LP) in pts with mRCC treated at our institution with m-TOR inhibitors (TM and EV), between June 2010 and August 2012. We evaluated TC and TG levels. Pts with hypothyroidism (previous treatment with sunitinib) and pts without baseline LP were excluded.

Results: We evaluated five pts, 4♂, 1♀, aged between 55 and 70 years. Three patients were treated with TM and two with EV. All patients had dyslipidemia at baseline. Average TC and TG values were assessed before treatment: CT 224±54 mg/dl (191 mg/dl – TM group vs 275 mg/dl – EV group); TG 247±115 mg/dl (202 mg/dl-TM group vs 313 mg/dl-EV group). After therapy (med. 2.4 months): TC 278±137 mg/dl (+24%), TG 557±383 mg/dl (+126%). TC’s increase in the group of pts treated with TM and EV was +25% (with TM) vs +23% (with EV), and TG’s increase was +101% (with TM) vs +150% (with EV).

Conclusions: Therapy with m-TOR inhibitors in this small number of pts was associated with an increase in the lipid parameters assessed, especially TG. Metabolic toxicity in patients on TM and EV should be promptly addressed and requires an interaction between health professionals in order to develop evaluation and follow-up protocols.