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Management Strategies for Hyperglycemia Associated with the α-Selective PI3K Inhibitor Alpelisib for the Treatment of

Tsvetalina Tankova1, Elżbieta Senkus2, Maria Beloyartseva3

  • 1Department of Endocrinology, Medical University of Sofia, 2, Zdrave Str., 1431 Sofia, Bulgaria.

Cancers
|April 12, 2022
PubMed

Insights

Alpelisib treatment for PIK3CA-mutated breast cancer can cause hyperglycemia. Early detection and a multidisciplinary glycemic support program are crucial for managing this side effect and optimizing treatment.

Area of Science:

  • Oncology
  • Endocrinology
  • Pharmacology

Background:

  • Alpelisib is an effective treatment for HR+, HER2- PIK3CA-mutated breast cancer.
  • Hyperglycemia is a common on-target side effect of alpelisib, impacting ~60% of patients.
  • Unmanaged hyperglycemia can lead to dose modifications or treatment cessation, compromising therapeutic benefits.

Purpose of the Study:

  • To provide guidance on managing alpelisib-induced hyperglycemia.
  • To emphasize the importance of a proactive, multidisciplinary approach.
  • To outline strategies for hyperglycemia management before, during, and after alpelisib therapy.

Main Methods:

  • Consensus report based on the input of 14 oncologists and 7 endocrinologists.
  • Review of alpelisib's mechanism of action and its association with hyperglycemia.
  • Development of a stepwise antihyperglycemic regimen and lifestyle modification recommendations.

Main Results:

  • Hyperglycemia management requires early detection and timely intervention.
  • A collaborative endocrinology-oncology team approach is beneficial.
  • Key management tools include lifestyle modifications (reduced-carbohydrate diet) and a personalized antihyperglycemic regimen (metformin, SGLT2 inhibitors, pioglitazone).

Conclusions:

  • Effective hyperglycemia management is essential for maintaining alpelisib dose intensity and maximizing patient benefit.
  • A proactive, multidisciplinary strategy involving lifestyle changes and tailored pharmacotherapy is recommended.
  • This guidance supports optimal care for patients with HR+, HER2-, PIK3CA-mutated breast cancer receiving alpelisib.
Keywords:
PIK3CA-mutated metastatic breast canceradverse effectalpelisibhyperglycemia

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