Incidence, risk factors, and management of alpelisib-associated hyperglycemia in metastatic breast cancer Journal Article
| Authors: | Shen, S.; Chen, Y.; Carpio, A.; Chang, C.; Iyengar, N. M. |
| Article Title: | Incidence, risk factors, and management of alpelisib-associated hyperglycemia in metastatic breast cancer |
| Abstract: | Purpose: The combination of fulvestrant with alpelisib, a PI3K inhibitor, improves progression-free survival in metastatic hormone receptor–positive, PIK3CA-mutant breast cancer. This study describes the incidence, risk factors, and treatment of alpelisib-associated hyperglycemia. Methods: Patients with metastatic breast cancer who received alpelisib from 2013 to 2021 at Memorial Sloan Kettering Cancer Center were included in this retrospective study. Alpelisib prescription dates and patient/tumor characteristics were abstracted from medical records. Risk factors associated with hyperglycemia and alpelisib dose reduction/discontinuation were evaluated using Pearson’s χ2 tests. Results: Among 247 patients, baseline median body mass index was 25.4 kg/m2 and median hemoglobin A1c (HbA1c) was 5.5%. A total of 152 patients (61.5%) developed any-grade hyperglycemia and 72 patients (29.2%) developed grade 3–4 hyperglycemia; median time to onset was 16 days. A total of 100 patients (40.5%) received alpelisib on a clinical trial; rates of hyperglycemia were significantly higher in patients treated as standard care versus on a clinical trial (any-grade hyperglycemia 80.3% vs. 34.0%, grade 3–4 hyperglycemia 40.2% vs. 13.0%, p <.001). Baseline HbA1c was significantly associated with development of hyperglycemia (p <.001) and alpelisib dose reduction/discontinuation (p =.015). Among those who developed hyperglycemia, 101 (40.9%) received treatment, most commonly with metformin. A total of 49 patients (19.8%) were referred to an endocrinologist, which was associated with SGLT2 inhibitor prescription (p =.007). Conclusions: Rates of hyperglycemia among patients treated with alpelisib as standard care were significantly higher than patients treated on clinical trials. Elevated baseline HbA1c is associated with alpelisib-induced hyperglycemia and requiring dose modification. Optimization of glycemic status before alpelisib initiation should become routine practice. © 2023 American Cancer Society. |
| Keywords: | adult; aged; middle aged; retrospective studies; major clinical study; drug dose reduction; drug withdrawal; treatment duration; antineoplastic agent; clinical practice; disease association; breast cancer; antineoplastic combined chemotherapy protocols; incidence; epidermal growth factor receptor 2; cohort analysis; risk factors; obesity; pathology; breast neoplasms; medical record review; retrospective study; phosphatidylinositol 3 kinase; risk factor; exemestane; hyperglycemia; prescription; cancer center; body mass; breast tumor; diabetes mellitus; tamoxifen; insulin; receptor, erbb-2; glucose; letrozole; trastuzumab; metastatic breast cancer; metformin; sulfonylurea derivative; everolimus; patient referral; fulvestrant; phosphatidylinositol 3-kinases; selective estrogen receptor modulator; glycemic control; hemoglobin a1c; ganitumab; 2,4 thiazolidinedione derivative; endocrinologist; humans; human; male; female; article; alpelisib; drug-related side effects and adverse reactions; infigratinib; canagliflozin; glycated hemoglobin; dipeptidyl peptidase iv inhibitor; sodium glucose cotransporter 2 inhibitor; dapagliflozin; ketogenic diet; volagidemab; low carbohydrate diet |
| Journal Title: | Cancer |
| Volume: | 129 |
| Issue: | 24 |
| ISSN: | 0008-543X |
| Publisher: | Wiley Blackwell |
| Date Published: | 2023-12-15 |
| Start Page: | 3854 |
| End Page: | 3861 |
| Language: | English |
| DOI: | 10.1002/cncr.34928 |
| PUBMED: | 37743730 |
| PROVIDER: | scopus |
| PMCID: | PMC10863751 |
| DOI/URL: | |
| Notes: | Article -- Source: Scopus |
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