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Alpelisib-Induced Diabetes Mellitus: Case Report, Pharmacodynamics and Management Considerations

Begoña Pla Peris1, Alfonso Arranz Martin2, Anabel Ballesteros García3

  • 1Department of Endocrinology and Nutrition, Hospital Universitario de Castellón, Castellón, Spain.

Frontiers in Endocrinology
|February 18, 2022
PubMed
Abstract

Insights

Severe hyperglycemia is a common adverse event associated with alpelisib treatment for advanced breast cancer. Close glucose monitoring and intensive insulin therapy are crucial for managing this side effect and ensuring treatment effectiveness.

Area of Science:

  • Oncology
  • Endocrinology
  • Pharmacology

Background:

  • Alpelisib, a PI3K alpha inhibitor, treats advanced breast cancer.
  • The PI3K pathway regulates glucose metabolism.
  • Hyperglycemia is a known adverse event of alpelisib.

Observation:

  • A patient with metastatic breast cancer experienced severe hyperglycemia after starting alpelisib.
  • Flash glucose monitoring revealed rapid onset and persistent hyperglycemia.
  • C-peptide levels indicated significant insulin resistance.

Findings:

  • Alpelisib significantly impairs glycemic control, necessitating intensive insulin regimens.
  • Hyperglycemia develops rapidly (within 24 hours) and is transiently affected by drug intake.
  • Flash glucose monitoring aids in understanding alpelisib's pharmacodynamics and insulin titration.

Implications:

  • Continuous glucose monitoring is essential for patients on alpelisib, particularly those with pre-existing diabetes or prediabetes.
  • Prompt management of hyperglycemia is critical to prevent treatment discontinuation and maintain efficacy.
  • Effective glycemic control ensures patients receive the full benefits of alpelisib, potentially impacting survival.
Keywords:
PI3K inhibitoralpelisibdiabetes mellitusflash glucose monitoring (FGM)hyperglycemia

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