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Abstract
INTRODUCTION
Alpelisib is a phosphoinositide 3-kinase kinase (PI3K) inhibitor indicated for the treatment of postmenopausal women and men with hormone receptor (HR)- positive, human epidermal growth factor receptor 2 (HER2)-negative, PIK3CA-mutated, advanced, or metastatic breast cancer. In combination with Fulvestrant, it has shown to significantly improved progression-free survival since its approval in May 2019. Frequent, yet reversible, side effects including hyperglycemia, cutaneous reactions, diarrhea, and pneumonitis have been described.
METHODS
Literature on the topic is reviewed.
CASE PRESENTATION
64-year-old female with past medical history of Sjögren syndrome and metastatic breast cancer that presented with progressively worsening fatigue. Admission laboratory results showed a blood glucose of 600 mg/dL, bicarbonate of 11 mmol/L (21-33 mmol/L), anion gap of 20 mmol/L (0-12 mmol/L), beta hydroxybutyrate of 91 mg/dL and a urinalysis with positive ketones, all consistent with diabetic ketoacidosis (DKA). Glycosylated hemoglobin was 11.3%. She had no known history of prediabetes or diabetes mellitus. Two months prior to presentation, she had started treatment with Alpelisib for metastatic breast cancer. DKA was treated according to protocol. Basal and prandial were prescribed upon discharge. Two weeks after suspension of Alpelisib plasma glucose values returned to baseline and insulin was stopped.
CONCLUSION
Hyperglycemia has been described in 65% of patients treated with Alpelisib. Ketoacidosis was reported in 0.7% of patients. A median time of 15 days has been reported for the occurrence of the first hyperglycemia episode. Treatment consists of anti-diabetic medications and close monitoring of blood glucose. Based on the severity of the hyperglycemia, drug interruption or dose reduction might be necessary. The safety of Alpelisib in patients with type 1 and uncontrolled type 2 diabetes has not been established as these were excluded from clinical trials. Alpelisib-induced hyperglycemia is a manageable adverse effect, active monitoring and prompt intervention are needed to prevent further complications.
Publication Date
2021
Keywords
diabetic ketoacidosis, breast cancer, alpelisib, hyperglycemia
Disciplines
Endocrinology, Diabetes, and Metabolism
Faculty Advisor/Mentor
Angeliki Stamatouli
Is Part Of
VCU Graduate Research Posters