Many Receiving Alpelisib for Metastatic Breast Cancer Have Hyperglycemia

MONDAY, Sept. 25, 2023 (HealthDay News) -- For patients with metastatic breast cancer receiving the PI3K inhibitor alpelisib, hyperglycemia often occurs, with a median time to onset of 16 days, according to a study published online Sept. 25 in Cancer.

Sherry Shen, M.D., from the Memorial Sloan Kettering Cancer Center in New York City, and colleagues describe the incidence, risk factors, and treatment of alpelisib‐associated hyperglycemia among patients with metastatic breast cancer who received alpelisib from 2013 to 2021.

Data were included for 247 patients; 152 (61.5 percent) developed any-grade hyperglycemia and 72 (29.2 percent) developed grade 3 to 4 hyperglycemia. There was a median of 16 days to hyperglycemia onset. The researchers found that 100 patients (40.5 percent) received alpelisib in a clinical trial; significantly higher rates of hyperglycemia were seen for patients treated as standard care versus in a clinical trial (any-grade hyperglycemia: 80.3 versus 34.0 percent; grade 3 to 4 hyperglycemia: 40.2 to 13.0 percent). There was a significant association seen for baseline hemoglobin A1c with development of hyperglycemia and alpelisib dose reduction/discontinuation. One hundred one (40.9 percent) of those who developed hyperglycemia received treatment, most often with metformin. Overall, 49 patients (19.8 percent) received referral to an endocrinologist, which was associated with prescription of sodium glucose cotransporter 2 inhibitor treatment.

"If a patient is identified to have a PI3KCA mutation and thus eligible for treatment with alpelisib, we should be checking hemoglobin A1c level and partnering with the patient's primary care physician and/or endocrinologist to optimize their blood sugar levels," Shen said in a statement. "This needs to be done months before initiating alpelisib, because once alpelisib is started, hyperglycemia usually develops within the first two weeks of treatment."

One author disclosed ties to pharmaceutical companies, including Novartis, the manufacturer of alpelisib.

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