Prognostic value of hyperglycaemia in the tumour environment for the outcomes of chemotherapy

M.C. Gerards, D.L. van der Velden, T.M. Vriesendorp, J.B.L. Hoekstra, V.E.A. Gerdes

Woensdag 20 april 2016

15:40 - 15:50u in Zaal 2.1

Categorieën: Parallelsessie

Parallel sessie: Parallelsessie 5: Case reports/research

Background: Glucocorticoids and other chemotherapeutic agents can provoke hyperglycaemia in patients with and without previously diagnosed diabetes. The effect of hyperglycaemia on the effectiveness of antineoplastic therapy is unknown.

Methods: We systematically reviewed the evidence on the effect of hyperglycaemia on the outcome of antineoplastic chemotherapy. MEDLINE was searched until December 2015 for intervention studies in which the response of cancer to chemotherapy was compared in a hyperglycaemic and normoglycaemic environment. We performed a narrative synthesis of results.

Results: Fourteen preclinical studies and 1 clinical study were included. In 9/14 preclinical studies cancer cells in a hyperglycaemic environment (glucose 10-25 mmol/L) were less likely to respond to various chemotherapeutic agents, as compared to cancer cells in a normoglycaemic environment (5 mmol/L). A clinical study that compared overall survival in intensive glucose lowering treatment (6.9 mmol/L) to regular treatment (7.9 mmol/L) was terminated early due to futility of effect.

Conclusion: Results of preclinical studies suggest that a hyperglycaemic tumour environment causes a deteriorated response on antineoplastic chemotherapy. This finding could not be confirmed in a randomized clinical trial. Possible reasons for the contradictory results are the small difference in glucose concentration between intensive and regular glucose lowering treatment and the adverse baseline conditions in the intensive control group.