Managing hyperglycemia and rash associated with alpelisib: expert consensus recommendations using the Delphi
Emily J Gallagher1, Heather Moore2, Mario E Lacouture3
1Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, and Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA. Emily.Gallagher@mssm.edu.
NPJ Breast Cancer
|January 31, 2024
Summary
Managing hyperglycemia and rash during phosphatidylinositol-3-kinase inhibition therapy, like with alpelisib, requires expert consensus. These recommendations offer guidance for effective patient management and improved clinical outcomes.
Area of Science:
- Oncology
- Pharmacology
- Endocrinology
Background:
- Phosphatidylinositol-3-kinase (PI3K) inhibitors, such as alpelisib, are associated with challenging adverse events including hyperglycemia and rash.
- Effective management strategies are crucial for patient adherence and treatment success.
Purpose of the Study:
- To establish consensus-based recommendations for managing hyperglycemia and rash in patients treated with alpelisib.
- To provide practical guidance for clinicians encountering these adverse events in clinical practice.
Main Methods:
- Two modified Delphi panels comprising experts were convened.
- Experts rated the appropriateness of various management interventions on a 1-to-9 scale.
- Median scores and dispersion were used to determine consensus levels.
Main Results:
- For hyperglycemia, starting alpelisib is appropriate for patients with HbA1c 6.5% to <8% or high risk, provided they have a pre-treatment endocrinology consult.
- Prophylactic metformin is recommended for patients with baseline HbA1c 5.7% to 6.4%, and it is the preferred first-line anti-hyperglycemic agent.
- For rash, prophylactic nonsedating H1 antihistamines are recommended, and these agents along with topical steroids are the preferred initial management.
Conclusions:
- These consensus recommendations provide a framework for managing hyperglycemia and rash during PI3K inhibition therapy.
- The guidelines aim to address gaps in clinical practice and support optimal patient care.
- Integrating these recommendations with clinical trial evidence can enhance patient outcomes.
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