New insights on a potentially serious side effect of the cancer drug alpelisib

Study assessed the incidence, risk factors, and management of alpelisib-associated high blood sugar in patients with metastatic breast cancer.

2023-09-25

(Press-News.org) New research has uncovered elevated rates of high blood sugar, or hyperglycemia, among patients with breast cancer who are treated with the oral medication alpelisib. The results are published by Wiley online in CANCER, a peer-reviewed journal of the American Cancer Society.

Alpelisib targets the phosphoinositide 3-kinase (PI3K) protein that is involved in cell growth and when mutated can contribute to cancer. In 2019, the US Food and Drug Administration approved the use of this drug in combination with fulvestrant, an estrogen receptor blocker, for certain cases of metastatic breast cancer that have mutations in the gene that codes for a PI3K subunit.

Unfortunately, targeting PI3K can lead to hyperglycemia as a side effect which, if severe, can result in dehydration or kidney damage and can require hospitalization. Sherry Shen, MD, of Memorial Sloan Kettering Cancer Center, and her colleagues set out to describe the incidence, risk factors, and treatment patterns of alpelisib-associated hyperglycemia in patients with metastatic breast cancer treated in a clinical trial or as standard care at their institution.

Among 147 patients treated with alpelisib as standard care, the rate of hyperglycemia was 80.3%, and the rate of serious hyperglycemia was 40.2%. Among 100 patients who were treated during a clinical trial, rates were lower (34.0% any grade and 13.0% serious hyperglycemia). The median time to onset of hyperglycemia after initiating alpelisib was 16 days. An initially elevated hemoglobin A1c, an indicator of high blood sugar such as in prediabetes or diabetes, was a risk factor for later developing hyperglycemia.

Among patients who developed hyperglycemia, 66.4% received treatment, most commonly with the diabetes drug metformin.

“If a patient is identified to have a PI3KCA mutation and thus eligible for treatment with alpelisib, we should be checking hemoglobin A1c level and partnering with the patient’s primary care physician and/or endocrinologist to optimize their blood sugar levels,” said Dr. Shen. “This needs to be done months before initiating alpelisib, because once alpelisib is started, hyperglycemia usually develops within the first two weeks of treatment. Being pre-emptive about improving glycemic status and treating prediabetes/diabetes will hopefully lower the patient’s risk of developing hyperglycemia and thus, lower their risk of needing to discontinue a drug that could be effective for their cancer.”

Senior author Neil M. Iyengar, MD noted that optimizing a patient’s blood sugar levels often involves changes to dietary and exercise patterns, and potentially introducing certain medications. “Improving metabolic risk factors through lifestyle interventions may also improve dose delivery of alpelisib, and ongoing clinical trials by our group and other groups are testing whether metabolic interventions such as the ketogenic diet or newer medications used to treat diabetes could also improve the treatment efficacy of cancer therapies that target the PI3K pathway,” he said.

Additional information
NOTE: The information contained in this release is protected by copyright. Please include journal attribution in all coverage. A free abstract of this article will be available via the CANCER Newsroom upon online publication. For more information or to obtain a PDF of any study, please contact: Sara Henning-Stout, newsroom@wiley.com

Full Citation:
“Incidence, risk factors, and management of alpelisib-associated hyperglycemia in metastatic breast cancer.” Sherry Shen, Yuan Chen, Andrea Carpio, Cassandra Chang, and Neil M. Iyengar. CANCER; Published Online: September 25, 2023 (DOI: 10.1002/cncr.34928).

URL Upon Publication: http://doi.wiley.com/10.1002/cncr.34928

Author Contact: John Connolly, Director of Media Relations at Memorial Sloan Kettering Cancer Center, at connolj@mskcc.org.

About the Journal
CANCER is a peer-reviewed publication of the American Cancer Society integrating scientific information from worldwide sources for all oncologic specialties. The objective of CANCER is to provide an interdisciplinary forum for the exchange of information among oncologic disciplines concerned with the etiology, course, and treatment of human cancer. CANCER is published on behalf of the American Cancer Society by Wiley and can be accessed online. Follow CANCER on Twitter @JournalCancer and Instagram @ACSJournalCancer, and stay up to date with the American Cancer Society Journals on LinkedIn.

About Wiley
Wiley is a knowledge company and a global leader in research, publishing, and knowledge solutions. Dedicated to the creation and application of knowledge, Wiley serves the world’s researchers, learners, innovators, and leaders, helping them achieve their goals and solve the world's most important challenges. For more than two centuries, Wiley has been delivering on its timeless mission to unlock human potential. Visit us at Wiley.com. Follow us on Facebook, Twitter, LinkedIn and Instagram.

END

ELSE PRESS RELEASES FROM THIS DATE:

Holidays back to the home country could help bilingual children hold on to their family’s original language

2023-09-25

It's hard to keep a language in the family. Many people who migrate to different countries find that their language of origin has become a heritage language, passed on to future generations with varying degrees of success. These languages come under pressure from the dominant language in a country as well as the lack of opportunities to practice and fluent speakers to practice with. So how do kids use or retain heritage languages? And can visits to their parents’ countries of origin help them increase their fluency? “The role of parental language use in the country of residence is well-established,” ...

ETRI unveiled hyper-realistic technologies for the metaverse world

2023-09-25

For the upcoming hyper-realistic metaverse world in the era of digital transformation, domestic researchers are showcased their achievements in the development of display and stereoscopic imaging technologies. Electronics and Telecommunications Research Institute(ETRI) participated in consecutive events, starting from the 16th August at COEX in Seoul for 'K-Display 2023,' followed by 'IMID 2023' at BEXCO in Busan from the 23rd, where they exhibited a variety of innovative technologies capable of realizing a truly realistic metaverse world. At this exhibition, ETRI unveiled a total of 11 technologies across four categories, including ▲hyper-realistic ...

New guideline to promote health equity in Canada

2023-09-25

A comprehensive new guideline with 16 preventive care recommendations aims to promote health equity for people disadvantaged because of racism, sexism and other forms of discrimination. The guideline, created by a diverse team of clinicians from across Canada with patient involvement, is published in CMAJ (Canadian Medical Association Journal): https://www.cmaj.ca/lookup/doi/10.1503/cmaj.230237 Some key recommendations: Colorectal cancer — prioritize colorectal cancer screening for patients starting at age 45 years ...

Global study provides new insights into barriers to effective cardiovascular rehabilitation for women and why women are less likely to participate

2023-09-25

Philadelphia, September 25, 2023 – Cardiovascular rehabilitation (CR) improves health outcomes and well-being and can reduce death and re-hospitalization rates by 20%. However, programs are underutilized and women are much less likely to participate than men, so they do not reap these benefits. This first global comparative study into barriers to using CR in men and women assesses the extent of these barriers and discusses ways in which patients can overcome them. It determined that women and men face some common, but also many different barriers, and barriers differ by global region. The study appears in the Canadian ...

Blue light from smartphones or tablets linked to early puberty

2023-09-24

Exposure to blue light, like that from smartphones or tablets, may lead to early puberty in male rats, according to research presented at the 61st Annual European Society for Paediatric Endocrinology Meeting in The Hague. This study is the first to investigate the association between blue light exposure and early puberty in male rats, and sheds light on how environmental factors, such as screen time, impact early puberty and testicular tissue, which could eventually lead to future prevention strategies for children. Early puberty for most children does not have an obvious cause. Sometimes it is due to genetics, or there is a problem in the brain, such as an injury or tumour, or in the thyroid, ...

Chromosome-scale genome sequence of Suaeda glauca sheds light on salt stress tolerance in halophytes

2023-09-23

Recently, a research paper titled "Chromosome-scale genome sequence of Suaeda glauca sheds light on salt stress tolerance in halophytes", completed by Professor Qin Yuan's team from the Center for Genomics, Haixia Institute of Science and Technology (Future Technology College) at Fujian Agriculture and Forestry University, has been published in the top-ranked journal "Horticulture Research" in the field of horticultural science. Soil salinity is a growing concern for global crop production ...

Tirzepatide more effective in blood sugar control and body weight loss than semaglutide, shows meta-analysis of 22 studies

2023-09-23

*Note- this is an early release from the Annual Meeting of the European Association for the Study of Diabetes (EASD) meeting in Hamburg, October 2-6. Please credit the meeting if you use this story* A new meta-analysis combining 22 studies, to be presented at this year’s Annual Meeting of the European Association for the Study of Diabetes (EASD) in Hamburg, Germany (2-6 October), shows that tirzepatide is superior to semaglutide for both control of blood sugar and in terms of amount of body weight lost by patients. The study is by Dr Thomas Karagiannis, Aristotle ...

NIH awards researchers $1.2M to develop robotic eye examination system

2023-09-22

A collaboration between researchers at the University of Illinois Urbana-Champaign and Duke University has developed a robotic eye examination system, and the National Institutes of Health has awarded the researchers $1.2 million to expand and refine the system. The researchers have developed a robotic system that automatically positions examination sensors to scan human eyes. It currently uses an optical scan technique which can operate from a reasonably safe distance from the eye, and now the researchers are working to add more features that will help it perform most steps of a standard eye exam. These features will require ...

Nanofluidic device generates power with saltwater

2023-09-22

There is a largely untapped energy source along the world’s coastlines: the difference in salinity between seawater and freshwater. A new nanodevice can harness this difference to generate power. A team of researchers at the University of Illinois Urbana-Champaign has reported a design for a nanofluidic device capable of converting ionic flow into usable electric power in the journal Nano Energy. The team believes that their device could be used to extract power from the natural ionic flows at seawater-freshwater boundaries. “While our design is still a concept at this stage, it is quite versatile and already ...

New program helps health professionals and community members determine health risks and create medical interventions for people experiencing homelessness

2023-09-22

New Program Helps Health Professionals and Community Members Determine Health Risks and Create Medical Interventions for People Experiencing Homelessness A consortium of population health professionals, physicians, frontline staff, and community partners in Toronto established the Community Assessment and Risk Evaluation (CARE) program, a rapid risk assessment and clinical population medicine intervention to respond to challenges faced by people experiencing homelessness (PEH). The intervention also helped characterize health needs and mitigate risks among this population. ...

LAST 30 PRESS RELEASES:

UK study shows there is less stigma against LGBTQ people than you might think, but people with mental health problems continue to experience higher levels of stigma