Current Management
Management
Unmet Needs
Guidelines for management have yet to be established1
Surgical standard of care
Resection is the preferred standard of care to mitigate both tumor growth and associated hypoglycemia but is often unfeasible due to the progression of the tumor or delayed diagnosis. In cases of resection, recurrence remains possible.1
Alternative approaches
For the majority of patients that will not benefit from resection, other tumor-directed therapies and medical or supportive management of hypoglycemia are applied.2
Treatment limitations
Conventional management strategies for hypoglycemia have limitations because most modify insulin production, which is not the mediator of hypoglycemia in NICTH. While glucocorticoids are the exception, they have dose-limiting side effects and are not always effective.2
The absence of safe and effective medical therapies, compounded with burden of supportive care options, creates significant unmet need for patients and strain on the care system.2,3
Without a targeted approach that appropriately inhibits insulin receptor signaling and excess IGF-2 production, hypoglycemia frequently escalates in patients with non-islet tumors, requiring repeated emergency intervention with rescue therapy, or long-term reliance on glucocorticoids.6,9,10
There is a high unmet need for medical therapies to manage NICTH2
Increased awareness
Greater understanding of the association of non-islet cell tumor hypoglycemia (NICTH) with malignancy among oncologists and other healthcare providers will allow for earlier detection and therefore intervention and management before an emergent event.2
Targeted therapy
There is a need for novel treatment strategies that effectively and safely target the excess production of IGF-2 variants associated with continuous dysregulation of insulin signaling.2
Multi-disciplinary approach
Early collaboration between oncologists and endocrinologists, ideally at first presentation of hypoglycemia (eg, mild disorientation), can improve patient prognosis and aid in avoiding repeated failures of symptom control.2
Could more be done for patients with NICTH?
Learn about the upLIFT Clinical Program
References: 1. Bodnar T, et al. Management of non-islet cell tumor hypoglycemia: a clinical review. J Clin Endocrinol Metab. 2013;99(3):713-722. doi:10.1210/jc.2013-3382 2. Karamanolis N, et al. Paraneoplastic hypoglycemia: an overview for optimal clinical guidance. Metab Open. 2024;23(100305):1-9. doi:10.1016/j.metop.2024.100305 3. Liu D, et al. A practical guide to the monitoring and management of the complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol. 2013;9(30):1-25. doi:10.1186/1710-1492-9-30 4. Siddiqui M, et al. Pasireotide: a novel treatment for tumor-induced hypoglycemia due to insulinoma and non-islet cell tumor hypoglycemia. J Endocr Soc. 2020;5(1):1-7. doi:10.1210/jendso/bvaa171 5. Hofland J, et al. Approach to the patient: insulinoma. J Clin Endocrinol Metab. 2024;109(4):1109-1118. 6. Korevaar T, et al. IGF2-induced hypoglycemia unresponsive to everolimus. Q J Med. 2011;107(4):297-300. doi:10.1093/qjmed/hcr249 7. Shoshana N, et al. Diazoxide for neonatal hyperinsulinemic hypoglycemia and pulmonary hypotension. Children. 2023;10(5). doi:10.3390/children10010005 8. Przezak A, et al. Fear of hypoglycemia—an underestimated problem. Brain Behav. 2022;12:e2633. 9. Voon K, et al. Three cases of non-islet cell tumor hypoglycemia highlighting efficacy of glucocorticoid treatment. JCEM Case Rep. 2023;1(4):1-4. doi:10.1210/jcemcr/luad045 10. Elsdai I, et al. Marked reduction in the hospital admission rate of a man with nonislet cell tumor hypoglycemia after starting steroids: a case report. Ann Med Surg. 2023;85(5):2007-2009. doi:10.1097/MS9.0000000000000537
