Common breast cancer drug Alpelisib may have an alarming side effect, finds study

Hyperglycemia Prevalence: A staggering 61.5% of patients developed hyperglycemia of any grade, with 29.2% experiencing severe grade 3–4 hyperglycemia.

Clinical Trial vs. Standard Care: Patients enrolled in clinical trials experienced significantly lower rates of hyperglycemia compared to those receiving alpelisib as standard care. Any-grade hyperglycemia affected 80.3% of standard care patients, while only 34.0% of clinical trial participants were affected. Similarly, severe grade 3–4 hyperglycemia was reported in 40.2% of standard care patients and in only 13.0% of those in clinical trials.

Baseline HbA1c: The study also highlights the importance of assessing baseline hemoglobin A1c (HbA1c) levels. Elevated baseline HbA1c was significantly associated with the development of hyperglycemia and the need for alpelisib dose reduction or discontinuation.

Hyperglycemia Management: Among patients who developed hyperglycemia, 40.9% received treatment, with metformin being the most commonly prescribed medication. Additionally, 19.8% of patients were referred to endocrinologists, and this was found to be associated with SGLT2 inhibitor prescriptions .

Reference: Incidence, risk factors, and management of alpelisib-associated hyperglycemia in metastatic breast cancer, Sherry Shen MD et al, First published: 25 September 2023, DOI: https://doi.org/10.1002/cncr.34928