Afreen Shariff

Overview:

I am an Endocrinologist, Assistant Professor of Medicine in the Division of Endocrinology, Diabetes and Metabolism and an Associate Director for the Multi-Disciplinary Toxicity Program at the Center for Cancer Immunotherapy at Duke Cancer Institute.  During my fellowship at Duke University, I developed an interest in managing endocrine toxicities from cancer drugs. Following the completion of my training, I continued as an endocrinologist and faculty at Duke with expertise in the field of Endo-Oncology, a new field at the intersection of endocrinology and oncology with a small number of experts nationally. I work closely with oncologists and other subspecialists to enhance access and provide high-value and personalized multidisciplinary clinical care for oncology patients receiving cancer therapy.

My experience with managing toxicities from cancer drugs lead me to identify that delay in access often leads to avoidable hospital admissions in high risk cancer patients. To enhance access, I developed a telehealth program targeting oncology patients with endocrine side effects from cancer drugs at Duke Cancer Institute. This service was launched during the SARS-CoV2 pandemic with a goal to keep our patients safe and to provide expert recommendations and triage to high acuity patients with in 48 hours. The most prominent success of the program has been reduction in wait times from an average of 52 days down to 1 day for recommendations. As an extension of this e-consult service, I started the Endo-Oncology program at Duke which is a trans-disciplinary program which has been successful at providing streamline care, expert triage through E-consults and quick access clinic appointments to high acuity patients.

Over the last few years, I have created strong partnerships, clinical infrastructure and framework that support cancer patients and more recently recognized the potential of AI-assisted clinical decision making to enhance interdisciplinary care for patients with immune related toxicities.

Positions:

Assistant Professor of Medicine

Medicine, Endocrinology, Metabolism, and Nutrition
School of Medicine

Member of the Duke Cancer Institute

Duke Cancer Institute
School of Medicine

Education:

M.B.B.S. 2008

University of Hyderabad (India)

Internal Medicine Residency

East Carolina University, Brody School of Medicine

Fellowship in Endocrinology, Metabolism and Nutrition, Medicine

Duke University School of Medicine

Publications:

What's the Price? Toxicities of Targeted Therapies in Breast Cancer Care.

Agents with mechanisms novel to breast cancer care have been approved to treat breast cancer. These agents include drugs that target cyclin-dependent kinases, phosphoinositide 3-kinase PI3KCA gene mutations, PARP, checkpoint regulation, and novel antibody-drug conjugates. However, these novel approaches bring a risk of toxicities quite different from those of conventional cytotoxic chemotherapy. Here, we review these agents and discuss related adverse events, with particular attention to endocrine, pulmonary, and dermatologic toxicities. Endocrine toxicities associated with novel cancer therapies for breast cancer are distinct and often present with symptoms related to the specific hormonal deficiencies and rarely hormonal excess. Given the complex and sometimes irreversible nature of these toxicities, once recognized, transdisciplinary management with an endocrinologist experienced with managing drug-related toxicities is encouraged. Drug-related pneumonitis is a serious concern with new targeted therapies. Presentation may not be easily distinguished, and a multidisciplinary team approach can optimize patient care. Heightened awareness is crucial for early detection and treatment. Management should follow recommendations provided by the National Cancer Institute Common Terminology Criteria for Adverse Events and agent-specific guidelines. Cutaneous toxicities from anticancer therapies represent a common and often poorly characterized challenge for patients with breast cancer. Although our understanding of dermatologic effects from novel therapies continues to improve, the breadth of toxicities spans all dermatologic conditions. Targeted therapies offer effective and often novel therapeutic strategies for patients with breast cancer but also bring new adverse event profiles. In this era, it will be important both to closely follow monitoring recommendations and to remain vigilant for emerging toxicities.
Authors
Anders, CK; LeBoeuf, NR; Bashoura, L; Faiz, SA; Shariff, AI; Thomas, A
MLA Citation
Anders, Carey K., et al. “What's the Price? Toxicities of Targeted Therapies in Breast Cancer Care.Am Soc Clin Oncol Educ Book, vol. 40, May 2020, pp. 55–70. Pubmed, doi:10.1200/EDBK_279465.
URI
https://scholars.duke.edu/individual/pub1441394
PMID
32421449
Source
pubmed
Published In
Am Soc Clin Oncol Educ Book
Volume
40
Published Date
Start Page
55
End Page
70
DOI
10.1200/EDBK_279465

Low-Carbohydrate and Very-Low-Carbohydrate Diets in Patients With Diabetes.

Low-carbohydrate diets have been advocated as an effective method for promoting weight loss in overweight and obese individuals and preventing and treating type 2 diabetes. This article reviews the differences between various low-carbohydrate eating plans and discusses the benefits and drawbacks of such a diet based on available evidence. It also offers practical pointers for clinicians.
Authors
Merrill, JD; Soliman, D; Kumar, N; Lim, S; Shariff, AI; Yancy, WS
MLA Citation
Merrill, Jennifer D., et al. “Low-Carbohydrate and Very-Low-Carbohydrate Diets in Patients With Diabetes.Diabetes Spectr, vol. 33, no. 2, May 2020, pp. 133–42. Pubmed, doi:10.2337/ds19-0070.
URI
https://scholars.duke.edu/individual/pub1441395
PMID
32425450
Source
pubmed
Published In
Diabetes Spectrum : a Publication of the American Diabetes Association
Volume
33
Published Date
Start Page
133
End Page
142
DOI
10.2337/ds19-0070

Novel cancer therapies and their association with diabetes.

Over the last decade, there has been a shift in the focus of cancer therapy from conventional cytotoxic drugs to therapies more specifically directed to cancer cells. These novel therapies include immunotherapy, targeted therapy and precision medicine, each developed in great part with a goal of limiting collateral destruction of normal tissues, while enhancing tumor destruction. Although this approach is sound in theory, even new, specific therapies have some undesirable, 'off target effects', in great part due to molecular pathways shared by neoplastic and normal cells. One such undesirable effect is hyperglycemia, which results from either the loss of immune tolerance and autoimmune destruction of pancreatic β-cells or dysregulation of the insulin signaling pathway resulting in insulin resistance. These distinct pathogenic mechanisms lead to clinical presentations similar to type 1 (T1DM) and type 2 (T2DM) diabetes mellitus. Both types of diabetes have been reported in patients across clinical trials, and data on the mechanism(s) for developing hyperglycemia, prevalence, prognosis and effect on cancer mortality is still emerging. With the rapidly expanding list of clinical indications for new cancer therapies, it is essential to understand the impact of their adverse effects. In this review, we focus on hyperglycemia and diabetes related to cancer therapies, describe what is known about mechanism(s) leading to dysregulated glucose metabolism and provide a guide to management of complex oncology patients with a new diagnosis of diabetes.
Authors
Shariff, AI; Syed, S; Shelby, RA; Force, J; Clarke, JM; D'Alessio, D; Corsino, L
MLA Citation
Shariff, Afreen Idris, et al. “Novel cancer therapies and their association with diabetes.J Mol Endocrinol, vol. 62, no. 2, Feb. 2019, pp. R187–99. Pubmed, doi:10.1530/JME-18-0002.
URI
https://scholars.duke.edu/individual/pub1361046
PMID
30532995
Source
pubmed
Published In
J Mol Endocrinol
Volume
62
Published Date
Start Page
R187
End Page
R199
DOI
10.1530/JME-18-0002

Cardiovascular Outcome Trial Update in Diabetes: New Evidence, Remaining Questions.

PURPOSE OF REVIEW: Seven trials of new agents to treat type 2 diabetes (T2DM) have been performed to assess cardiovascular (CV) safety. A significant amount of information regarding the effects of drugs in three classes is available, with new data from multiple other trials expected shortly. This article provides a summary of recently completed trials. RECENT FINDINGS: The dipeptidyl peptidase-4 inhibitors studied thus far do not alter the risk of major adverse CV events (MACE). Glucagon like peptide-1 receptor agonists liraglutide and semaglutide, and the sodium glucose cotransporter-2 inhibitor empagliflozin, significantly reduced the risk of MACE. Empagliflozin also decreased the risk of hospitalization for heart failure. Agents demonstrating a CV outcome benefit also improved parameters of renal function. Several newer antihyperglycemic agents have been found to reduce the risk of important CV complications in high-risk patients with T2DM. Future trials are needed to assess the effects of additional drugs and the impact of therapy in lower risk patients and provide additional information regarding non-CV safety outcomes.
Authors
Herbst, R; Bolton, W; Shariff, A; Green, JB
MLA Citation
Herbst, Rebecca, et al. “Cardiovascular Outcome Trial Update in Diabetes: New Evidence, Remaining Questions.Curr Diab Rep, vol. 17, no. 9, Sept. 2017, p. 67. Pubmed, doi:10.1007/s11892-017-0898-8.
URI
https://scholars.duke.edu/individual/pub1266474
PMID
28726152
Source
pubmed
Published In
Curr Diab Rep
Volume
17
Published Date
Start Page
67
DOI
10.1007/s11892-017-0898-8

Sodium-Glucose Cotransporter 2 Inhibitors and Diabetic Ketoacidosis: A Case Series From Three Academic Institutions.

Authors
Misaghian-Xanthos, N; Shariff, AI; Mekala, K; Fearrington, LR; Setji, TL; Aloi, JA; Buse, JB
MLA Citation
Misaghian-Xanthos, Negin, et al. “Sodium-Glucose Cotransporter 2 Inhibitors and Diabetic Ketoacidosis: A Case Series From Three Academic Institutions.Diabetes Care, vol. 40, no. 6, June 2017, pp. e65–66. Pubmed, doi:10.2337/dc16-2591.
URI
https://scholars.duke.edu/individual/pub1243679
PMID
28351898
Source
pubmed
Published In
Diabetes Care
Volume
40
Published Date
Start Page
e65
End Page
e66
DOI
10.2337/dc16-2591

Research Areas:

Immune Checkpoint Inhibitors
Immune-related Adverse Events
Immunotherapy
Immunotherapy--Complications