Management Strategies for Hyperglycemia Associated with the α-Selective PI3K Inhibitor Alpelisib for the Treatment of Breast Cancer

Cancers

Bela Mrinakova¹  Laura Mazilu²  Doina Catrinoiu²  Mladen Krnić³  Andrej Janež⁴  Tsvetalina Tankova⁵  Elżbieta Senkus⁶  Eduard Vrdoljak⁷  Ruth Percik⁸  Simona Borštnar⁹  Maria Beloyartseva^1,10  Mona Frolova^1,10  Katarina Petrakova^1,11  Yiola Marcou^1,12  Gábor Rubovszky^1,13  Alinta Hegmane^1,14  Zoltan Lengyel^1,15  Margarita Tokar^1,16 

[1] 1st Department of Oncology, Comenius University, Faculty of Medicine, Bratislava, Heydukova 10, 812 50 Bratislava, Slovakia;Department of Diabetology, Clinical Emergency Hospital of Constanta, Romania, Tomis Bvd. No. 145, 900591 Constanta, Romania;Department of Endocrinology, Clinical Hospital Center Split, School of Medicine, University of Split, Šoltanska 1, 21000 Split, Croatia;Department of Endocrinology, Diabetes and Metabolic Disease, University Medical Center, Zaloska 7, 1000 Ljubljana, Slovenia;Department of Endocrinology, Medical University of Sofia, 2, Zdrave Str., 1431 Sofia, Bulgaria;Department of Oncology & Radiotherapy, Medical University of Gdańsk, Smoluchowskiego 17, 80-214 Gdańsk, Poland;Department of Oncology, Clinical Hospital Center Split, School of Medicine, University of Split, Spinčićeva 1, 21000 Split, Croatia;Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Ramat Gan 52621, Israel;Division of Medical Oncology, Institute of Oncology Ljubljana, Zaloska 2, 1000 Ljubljana, Slovenia;Institution N.N. Blokhin National Medical Research Center of Oncology of the Ministry of Health of the Russian Federation, 23 Kashirskoye Avenue, 115478 Moscow, Russia;Masaryk Memorial Cancer Institute, Žlutý kopec 543/7, Brno-Střed-Staré, 602 00 Brno, Czech Republic;Medical Oncology Department, The Bank of Cyprus Oncology Centre, 32 Acropoleos Avenue, Strovolos, Nicosia 2006, Cyprus;National Institute of Oncology, Rath Gy. Str. 7-9, 1122 Budapest, Hungary;Out-Patient Department of Medical Oncology, Riga East University Hospital, Oncology Center of Latvia, 4, Hipokrata Str., LV1079 Riga, Latvia;Szent János Hospital, Diós árok 1-3, 1125 Budapest, Hungary;The Legacy Heritage Oncology Center and Dr. Larry Norton Institute, SorokaMedical Center, Yitzhack I. Rager Blvd 151, Be’er Sheva, Israel;

关键词: adverse effect;    alpelisib;    hyperglycemia;    PIK3CA-mutated metastatic breast cancer;   

DOI  :  10.3390/cancers14071598

来源: DOAJ

【 摘 要 】

Alpelisib is an α-selective phosphatidylinositol 3-kinase inhibitor used for treating hormone receptor-positive (HR+), human epidermal growth receptor 2-negative (HER2–), PIK3CA-mutated locally advanced or metastatic breast cancer following disease progression on or after endocrine therapy. Hyperglycemia is an on-target effect of alpelisib affecting approximately 60% of treated patients, and sometimes necessitating dose reductions, treatment interruptions, or discontinuation of alpelisib. Early detection of hyperglycemia and timely intervention have a key role in achieving optimal glycemic control and maintaining alpelisib dose intensity to optimize the benefit of this drug. A glycemic support program implemented by an endocrinology–oncology collaborative team may be very useful in this regard. Lifestyle modifications, mainly comprising a reduced-carbohydrate diet, and a designated stepwise, personalized antihyperglycemic regimen, based on metformin, sodium–glucose co-transporter 2 inhibitors, and pioglitazone, are the main tools required to address the insulin-resistant hyperglycemia induced by alpelisib. In this report, based on the consensus of 14 oncologists and seven endocrinologists, we provide guidance for hyperglycemia management strategies before, during, and after alpelisib therapy for HR+, HER2–, PIK3CA-mutated breast cancer, with a focus on a proactive, multidisciplinary approach.

【 授权许可】

Unknown