Tankova Tsvetalina, Senkus Elżbieta, Beloyartseva Maria, Borštnar Simona, Catrinoiu Doina, Frolova Mona, Hegmane Alinta, Janež Andrej, Krnić Mladen, Lengyel Zoltan, Marcou Yiola, Mazilu Laura, Mrinakova Bela, Percik Ruth, Petrakova Katarina, Rubovszky Gábor, Tokar Margarita, Vrdoljak Eduard
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.
Cancers (Basel). 2022 Mar 22;14(7):1598. doi: 10.3390/cancers14071598.
Alpelisib is an α-selective phosphatidylinositol 3-kinase inhibitor used for treating hormone receptor-positive (HR+), human epidermal growth receptor 2-negative (HER2-), -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-, -mutated breast cancer, with a focus on a proactive, multidisciplinary approach.
阿哌利西布是一种α选择性磷脂酰肌醇3激酶抑制剂，用于治疗激素受体阳性（HR+）、人表皮生长因子受体2阴性（HER2-）、在内分泌治疗期间或之后疾病进展的局部晚期或转移性乳腺癌。高血糖是阿哌利西布的一种靶向效应，约60%接受治疗的患者会出现，有时需要降低剂量、中断治疗或停用阿哌利西布。早期发现高血糖并及时干预对于实现最佳血糖控制和维持阿哌利西布剂量强度以优化该药物的疗效至关重要。内分泌肿瘤协作团队实施的血糖支持计划在这方面可能非常有用。生活方式的改变，主要包括低碳水化合物饮食，以及基于二甲双胍、钠-葡萄糖协同转运蛋白2抑制剂和吡格列酮的指定的逐步个性化降糖方案，是应对阿哌利西布诱导的胰岛素抵抗性高血糖所需的主要手段。在本报告中，基于14名肿瘤学家和7名内分泌学家的共识，我们为HR+、HER2-、突变型乳腺癌患者在阿哌利西布治疗前、治疗期间和治疗后的高血糖管理策略提供指导，重点是积极主动的多学科方法。
