Management of side-effects of targeted therapies in renal cancer: endocrine side-effects and metabolic disorders

摘要

Several types of endocrine complications and metabolic disorders can occur during treatment with targeted therapies: thyroid dysfunction, hyperglycaemia, hyperlipidae-mia, etc. Thyroid dysfunctions are mainly observed with tyrosine kinase inhibitors (TKI), with a high frequency with sunitinib (18 to 85%) and sorafenib (21%). Hypothyroidism can be symptomatic with clinical signs including asthenia, constipation, cold intolerance, with elevated TSH and low free T4 levels; or subclinical with non-specific clinical signs (asthenia) with TSH less than 8-10 mlU/L and free T4 normal, and often requiring supplementation with thyroid hormones. The occurrence of thyroid dysfunction does not mean that treatment with TKI must be stopped. Thyrotoxicosis, usually transient, can precede the onset of hypothyroidism during treatment with TKI. Specialist opinion from an endocrinologist should be considered with the occurrence of thyroid dysfunction. Abnormalities in the glycaemic and lipid profile are often seen with mTOR inhibitors and require monitoring before and during the treatment, as well as a specialist opinion from an endocrinologist in the event of hyperglycaemia or dyslipidaemia.