Lipid‐lowering therapy of everolimus‐related severe hypertriglyceridaemia in a pancreatic neuroendocrine tumour (pNET)

• Published in: Journal of clinical pharmacy and therapeutics Vol. 43; no. 1; pp. 114 - 116
• Main Authors: De Gennaro Colonna, V., Pavanello, C., Rusconi, F., Sartore‐Bianchi, A., Siena, S., Castelnuovo, S., Sirtori, C. R., Mombelli, G.
• Format: Journal Article
• Language: English
• Published: England Hindawi Limited 01.02.2018
• Subjects: Aged; Antineoplastic Agents - adverse effects; Antineoplastic Agents - therapeutic use; Case reports; everolimus; Everolimus - adverse effects; Everolimus - therapeutic use; Female; Fenofibrate; Humans; hypertriglyceridaemia; Hypertriglyceridemia - chemically induced; mammalian target of rapamycin inhibitors; Neuroendocrine tumors; Neuroendocrine Tumors - drug therapy; Pancreas; Pancreatic cancer; Pancreatic Neoplasms - drug therapy; Targeted cancer therapy; everolimus; fenofibrate; hypertriglyceridaemia; mammalian target of rapamycin inhibitors
• ISSN: 0269-4727; 1365-2710
• DOI: 10.1111/jcpt.12588

Summary What is known and objective Hypertriglyceridaemia (HTG) is a potentially serious side effect of everolimus therapy. We here report a case of severe HTG in an everolimus‐treated patient and provide recommendations for its management. Case summary The patient was a 70‐year‐old woman, being treated with everolimus for a pancreatic neuroendocrine tumour (pNET). She developed severe HTG to a maximum of 969 mg/dL after 22 months of therapy. Treatment with fenofibrate rapidly normalized triglyceride (TG) levels. What is new and conclusion Severe HTG may occur in everolimus‐treated patients. Prescription of the appropriate therapy can allow patients to continue this medication. Treatment with everolimus induces severe hypertriglyceridemia, possibly decreasing lipoprotein lipase (LPL) activity, reducing degradation of apolipoprotein B100 (apoB100) and upregulating the adipocyte fatty acid‐binding protein (aP2) expression. After treatment with fenofibrate 145 mg/day, triglycerides (TG) levels strikingly decrease by about 32%.