Managing hyperglycemia and rash associated with alpelisib: expert consensus recommendations using the Delphi technique Journal Article

   

Authors:	Gallagher, E. J.; Moore, H.; Lacouture, M. E.; Dent, S. F.; Farooki, A.; Goncalves, M. D.; Isaacs, C.; Johnston, A.; Juric, D.; Quandt, Z.; Spring, L.; Berman, B.; Decker, M.; Hortobagyi, G. N.; Kaffenberger, B. H.; Kwong, B. Y.; Pluard, T.; Rao, R.; Schwartzberg, L.; Broder, M. S.
Article Title:	Managing hyperglycemia and rash associated with alpelisib: expert consensus recommendations using the Delphi technique
Abstract:	Hyperglycemia and rash are expected but challenging adverse events of phosphatidylinositol-3-kinase inhibition (such as with alpelisib). Two modified Delphi panels were conducted to provide consensus recommendations for managing hyperglycemia and rash in patients taking alpelisib. Experts rated the appropriateness of interventions on a 1-to-9 scale; median scores and dispersion were used to classify the levels of agreement. Per the hyperglycemia panel, it is appropriate to start alpelisib in patients with HbA1c 6.5% (diabetes) to <8%, or at highest risk for developing hyperglycemia, if they have a pre-treatment endocrinology consult. Recommend prophylactic metformin in patients with baseline HbA1c 5.7% to 6.4%. Metformin is the preferred first-line anti-hyperglycemic agent. Per the rash panel, initiate prophylactic nonsedating H1 antihistamines in patients starting alpelisib. Nonsedating H1 antihistamines and topical steroids are the preferred initial management for rash. In addition to clinical trial evidence, these recommendations will help address gaps encountered in clinical practice. © 2024, The Author(s).
Keywords:	clinical trial; drug withdrawal; follow up; clinical practice; consensus; obesity; steroid; data base; risk factor; hyperglycemia; rash; questionnaire; body mass; prophylaxis; diabetes mellitus; data analysis; insulin; physician; rating scale; glomerulus filtration rate; delphi study; corticosteroid; metformin; non insulin dependent diabetes mellitus; socioeconomics; antihistaminic agent; angioneurotic edema; knowledge; dermatologist; fluocinonide; structured questionnaire; demographics; pharmacist; oncologist; triamcinolone acetonide; hemoglobin a1c; loratadine; betamethasone dipropionate; 2,4 thiazolidinedione derivative; sulfonylurea; fexofenadine; cetirizine; human; article; alpelisib; blood glucose monitoring; dipeptidyl peptidase iv inhibitor; sodium glucose cotransporter 2 inhibitor; levocetirizine
Journal Title:	npj Breast Cancer
Volume:	10
ISSN:	2374-4677
Publisher:	Nature Publishing Group
Date Published:	2024-01-01
Start Page:	12
Language:	English
DOI:	10.1038/s41523-024-00613-x
PROVIDER:	scopus
PMCID:	PMC10831089
PUBMED:	38297009
DOI/URL:	https://www.scopus.com/inward/record.uri?eid=2-s2.0-85183771532&doi=10.1038%2fs41523-024-00613-x&partnerID=40&md5=5815d31867153b870c745eb90bec1be3
Notes:	Source: Scopus

https://synapse.mskcc.org/synapse/works/has_related_data_chk/213932