C109
Case Report: treatment of insulinoma related hypoglycaemia with Everolimus (RAD001) therapy
Jonathan Chambers, William Berg
1Novartis, Oncology, Frimley, UK, 2Novartis, Global Medical Affairs, New Jersey, USA
Background
Islet cell tumour patient had blood glucose levels controlled with diazoxide, prednisolone and octreotide (300mcg). Primary tumour and metastases were increasing in size. With frequent attacks of hypoglycaemia and blood sugars under 1.5mmol/l, patient started chemotherapy with temozolomide. Blood glucose levels were difficult to control. Patient had 40mg Sandostatin LAR and octreotide 500mcg/day with increased diazoxide, prednisolone 7.5mg bd and 5% dextrose. Patient had food every 2 hrs and Lucozade maintained blood sugars above danger levels. Blood sugars of 1-2mmol/l and patient gained weight. It was difficult to control hypoglycaemia due to the insulinoma.
Aim
Hyperglycaemia is a known side effect of Everolimus. Everolimus is a mTOR inhibitor available for patients with neuroendocrine tumours on compassionate grounds. The patient was given Everolimus 10 mg od to stabilise blood glucose levels.
Results
Patient blood glucose levels increased to 11mmol/l in 48 hrs. Patient stopped Lucozade & 2 hourly feeding. Everolimus did not produce any side effects. The patients serum insulin levels decreased. Octreotide bd was stopped, prednisolone halved and patient remained normoglycaemic. No hypoglycaemic episodes have occurred since starting on Everolimus. By stopping octreotide the patient is not getting diabetic blood glucose levels. Everolimus dose reduced 10-5mg. Patient remained on 350mg diazoxide od and 7.5mg od prednisolone.
Conclusion
Everolimus improved blood glucose levels in patient with malignant insulinoma whose blood glucose levels were out of control despite diazoxide and octreotide therapy. The increase in blood glucose levels was dramatic and had a significant improvement on the patients quality of life.
