Management of metabolic adverse events of targeted therapies and immune checkpoint inhibitors in cancer patients: an Associazione Italiana Oncologia Medica (AIOM)/Associazione Medici Diabetologi (AMD)/Società Italiana Farmacologia (SIF) multidisciplinary consensus position paper

https://doi.org/10.1016/j.critrevonc.2020.103066Get rights and content
Under a Creative Commons license
open access

Abstract

The growing insights in the next-generation immunotherapy and the state-of-the-art advancement in targeted-agents significantly improved clinical outcome of cancer patients by pointing towards a unexplored Achilles’ heel. Novel toxicity profiles have been uncovered, representing unmet medical needs. Thus, a panel of expert provide comprehensive pharmacological and clinical evidence, to provide a patient-tailored approach to metabolic adverse events associated with novel anti-cancer treatments. Prompted by the need of a multidisciplinary cooperation, a working group of Associazione Italiana Oncologia Medica (AIOM), Associazione Medici Diabetologi (AMD) and Società Italiana Farmacologia (SIF) examined the available literature data. The identification of patient risk profile and the characterization of metabolic effects of novel anti-tumour drugs is clearly a clinical challenge that can be addressed by a multidisciplinary clinical approach. Therefore, this review pinpoints the relevance of the challenging profiling of the patient suffering from dysmetabolic conditions induced by the novel therapeutics in medical oncology.

Keywords

metabolic effect
diabetes
targeted therapy
immunotherapy
hyperglycemia
dyslipidemia
hypercholesterolemia
hypertriglyceridemia

Cited by (0)

Nicola Silvestris is an Associate Professor of Medical Oncology at the University of Bari (Italy). He lends his teaching, research and assistance activities at the Department of Internal Medicine and Medical Oncology (DIMO) of the Faculty of Medicine of Bari and at the Cancer Institute “Giovanni Paolo II” of Bari. He was a Scientific Director of the Cancer Center of Bari until June 2019. He is a National Councilior of the Italian Association of Medical Oncology (AIOM). He is an author of over 210 publications in scientific journals with an impact factor. Over the past 15 years he has dedicated a large part of his research and assistance to patients suffering from gastrointestinal malignancies, with particular regard to hepato-biliary-pancreatic tumors. He has also been a speaker at over 300 national and international conferences.

Antonella Argentiero is a medical consultant as clinical oncologist with permanent position as attendant physician at the IRCCS, Istituto Tumori “Giovanni Paolo II” of Bari, Italy. She graduated in medicine and surgery in 2011 and completed her post-graduate residency program in medical oncology at School of Medicine of the University of Bari “Aldo Moro” with Magna cum Laude in 2017. She has been performing routine clinical and medical activities in the area of internal medicine and oncology as interdepartmental shifts and duties. Her main interests of research are represented by medical oncology, with particular focus on the immune-oncology and gastrointestinal cancer. In 2014, she has collaborated in preclinical research at Sbarro Health Research Organization, College of Science and Technology, Temple University of Philadelphia. Since that year, she is an associate member of Italian Association of Medical Oncology (AIOM) as well.

Giordano Domenico Beretta, Graduated in Medicine at Milan University in 1983 with 110/110 and laude. Specialized in Medical Oncology in the same University in 1986 with 70/70 and laude. From December 1980 to March 1983 he attended Medical Oncology Unit of San Carlo Hospital in Milan as student and medical resident. For three years (1986-1988) he had a grant by AIRC (Italian Association in Cancer Research) for a research regarding tumor marker’s study. He worked in Internal Medical Division of Bassini Hospital in Cinisello Balsamo (Milan) from March 1989 to September 1997 (where he was responsible of Oncology Section from May 1990). He was responsible for Oncology Section in Medical Division in Sesto San Giovanni Hospital (Milan) from September 1997 to December 1997. He worked as deputy director in Oncology Unit of Ospedali Riuniti in Bergamo from January 1998 until April 2006, where he was coordinator of GIOG (Gastrointestinal Interdisciplinary Oncology Group) and he was director of Oncology Gastrointestinal Unit since January 2003 until April 2006 in the same hospital. He was Director of Medical Oncology Unit of Sant’Orsola-Fatebenefratelli Hospital in Brescia since May 2006 until April 2010. He was Director of Medical Oncology Unit and Internal Medicine Unit of Humanitas Gavazzeni in Bergamo from May 2010 to April 2018. Now, he is Director of Medical Oncology Unit from April 2018. He is AIOM member from 1985 and Regional Coordinator of Lombardy AIOM section from 2009 to 2013. He was member of AIOM of National Committee from 2013 to 2015 and he was National Secretary of AIOM from 2015 now 2017 and now he is AIOM President. He is member of ESMO since October 1991 and in November 1996 he obtained European Certification of Medical Oncology in Vienna. He is member of ASCO since January 2000. He is author or co-author of more than 200 publications.

Monica Montagnani Associate Professor of Pharmacology at the Department of Biomedical Sciences and Human Oncology, University of Bari, Medical School. Research interests are focused on diabetes, insulin resistance and vascular complication, cellular and molecular signaling of endocrine mediators in endothelium. Member of Pharmacology and Hypertension Scientific Societies (SIF, SIIA) and editorial board member in scientific Journals. Invited speaker and chairman at National and International congresses; co-author of over 70 scientific publications indexed in PubMed and Scopus (h-index 28, more than 5700 citations).

Romano Danesi is Professor of Pharmacology at the University of Pisa, Italy. He received board certification in Respiratory diseases, Clinical Pharmacology and Oncology from the University of Pisa, Italy. His current research interests are in the field of cancer pharmacogenetics and since 2002 is independent reviewer for the European Commission and many other funding organizations including Academy of Finland, Norvegian Research Council and UK MRC.

Pietro Ferrari is full-time Director of the Palliative Care Unit and Home Care Service at IRCCS Istituti Clinici Scientifici Maugeri Pavia, Italy. Dr Ferrari was born in Pavia on January, 21th 1970. After graduating from medical school at the University of Pavia in 1996, he was board certified in Internal Medicine in 2003. His clinical and research experience include the palliative treatment of advanced oncological and non-oncological diseases with particular attention to their relation to diabetes and other metabolic consequences.

Stella D’Oronzo graduated with honors as a Medical Doctor in 2011 at the University of Bari (Italy) and gained the national certification to the Medical Practice in 2012. At the same University, Dr D'Oronzo completed her post-graduate residency program in Medical Oncology in 2017 and earned a PhD degree in "Biomolecular, Pharmaceutical and Medical Sciences". During her PhD course, Dr D'Oronzo spent about two years at the University of Sheffield (UK) as a Visiting Research Fellow in the "Department of Oncology and Metabolism". In 2018 she gained the "Cancer and Bone Society Young Investigator Award" for her research on osteotropic malignancies, especially focused on mechanisms of breast cancer homing towards bone, identification of predictive/prognostic biomarkers in bone metastatic breast cancer and investigation of cancer-treatment related complications. Since 2019 Dr D'Oronzo is an Assistant Professor in Medical Oncology at the University of Bari.

Antonio Russo is an Associate Professor of Medical Oncology at the University of Palermo (Italy). He is head of the Medical Oncology Unit and of the Reference Center of Rare and Heredo-familial Solid Tumors, Palermo (Italy). In addition, he is Coordinator of the PhD in Oncology at the University of Palermo and Adjunct Full Professor at Temple University’s, Philadelphia (USA). He is a medical oncologist and he focuses on translational oncology, hereditary, rare, lung, gastrointestinal and ovarian cancers. Previously he was Director of the Specialization School in Medical Oncology, University of Palermo. He was co-chair of the “CRCP53 International Collaborative Study” project and also member of the international RASCAL II project group. He is an active member of the main scientific oncological groups as ASCO, ESMO, ISBL and AIOM, of which he is a member of the national board of councillors. He was an expert member of INSERM (France), of the Scientific Committee INCA (France) and of the NWCRF (UK). Recently, he has been the recipient of numerous professional accolades, including a Visiting Professor and an Honorary Professor membership for the Peruvian Ricardo Palma University. In 2019 he also received the prestigious NIAF Award for Ethics and creativity in Medical research in Washington (USA). He is the author of more than 300 peer-reviewed publications listed on Medline-PubMed including Journal of Clinical Oncology, Lancet, Annals of Oncology, Oncoimmunology, Lancet Oncology, Oncologist, Cell Stem Cell. He is Editor-in-Chief of several academic textbooks in oncology for Springer Nature.

Silvia Acquati is full-time MD at the Endocrinology Unit of the Hospital Morgagni in Forlì, AUSl Romagna, Italy. She graduated in medicine and surgery in 1999 at the Universiity of Milan and specialized in Endocrinology and Metabolic Diseasee in 2004 at the University of Ferrara. She has been performing routine clinical and medical activities in the area of diabetes and diabetic foot. Her clinical and research experience include type 1 and type 2 diabetes, use of technologies in patients affected by diabetes, gestational diabetes and diabetic foot.

Marco Gallo is full-time Assistant Medical Director/Endocrinologist at the Oncological Endocrinology Unit of the University Hospital "Città della Salute e della Scienza di Torino - Molinette”, Turin, Italy. Dr Gallo’s research interest include diabetes, diabetes and cancer, hormones and cancer, and endocrine cancers. He is author of more than 120 peer-reviewed articles (48 indexed in PubMed) in journals including American Journal of Medicine, British Journal of Cancer, Cancer, Diabetes Care, Endocrine Related Cancer, Lancet Diabetes & Endocrinology, Metabolism, and Thyroid. He is reviewer for several international scientific journals.

1

co-first authors.

2

co-last authors.