This study evaluated the occurrence, contributing factors, and treatment strategies of alpelisib-induced hyperglycemia in patients with metastatic breast cancer.
A recent study found that breast cancer patients treated with the oral drug alpelisib have an increased incidence of hyperglycemia, or hyperglycemia. This finding is detailed in a recent study published in October 2016. cancera peer-reviewed journal of the American Cancer Society.
Alpelisib is a drug that specifically inhibits the phosphoinositide 3-kinase (PI3K) protein, which plays an important role in cell proliferation. Mutations in this protein can lead to the development of cancer. In 2019, the U.S. Food and Drug Administration approved the combination of fulvestrant, a drug that blocks estrogen receptors, with alpelisib to treat certain types of metastatic breast cancer characterized by mutations in the gene encoding the PI3K subunit. was approved.
Side effects and research results
Unfortunately, targeting PI3K can cause hyperglycemia as a side effect, and in severe cases can cause dehydration and kidney damage, requiring hospitalization. Shelley Shen, MD, of Memorial Sloan Kettering Cancer Center, and colleagues study the incidence, risk factors, and treatment patterns of alpelisib-associated hyperglycemia in patients with metastatic breast cancer treated in clinical trials or as standard of care in the hospital. I set out to explain. institution.
Among the 147 patients treated with alpelisib as standard of care, the rate of hyperglycemia was 80.3% and the rate of severe hyperglycemia was 40.2%. Among the 100 patients treated during the clinical trial, the rates were lower (34.0% any grade, 13.0% severe hyperglycemia). The median time to onset of hyperglycemia after initiation of alpelisib was 16 days. An initial increase in hemoglobin A1c, an indicator of hyperglycemia in conditions such as prediabetes and diabetes, was a risk factor for later development of hyperglycemia.
Of those who developed hyperglycemia, 66.4% received treatment, most commonly with the diabetes drug metformin.
Hyperglycemia management and future direction
“If a patient is identified as having a PI3KCA mutation and is a candidate for treatment with alpelisib, hemoglobin A1c levels should be checked and blood sugar levels should be optimized in collaboration with the patient’s primary care physician and endocrinologist.” said Dr. Shen. . “This should be done several months before starting alpelisib, as hyperglycemia usually develops within the first two weeks after treatment. Improving glycemic status and treating prediabetes/diabetes By doing this proactively, we hope to reduce the risk of patients developing hyperglycemia, which in turn reduces the risk of having to stop potentially effective cancer-fighting drugs.”
Lead author Neil M. Iyengar, MD, noted that optimizing a patient’s blood sugar levels may require changes in diet and exercise patterns, as well as the introduction of certain medications. “Improving metabolic risk factors through lifestyle interventions may also improve the dosing of alpelisib, and ongoing clinical trials by our group and others suggest that it may be used on a ketogenic diet or in the treatment of diabetes.” “We are testing whether metabolic interventions, such as new drugs, can also improve the efficacy of diabetes treatments,” he said. “Cancer treatments targeting the PI3K pathway.”
Reference: “Incidence, Risk Factors, and Management of Alpelisib-Associated Hyperglycemia in Metastatic Breast Cancer,” by Sherry Shen, Yuan Chen, Andrea Carpio, Cassandra Chang, and Neil M. Iyengar, September 25, 2023. cancer.
DOI: 10.1002/cncr.34928