Ulene Sophie R, Wang Shikun, Cook Joshua R, McAuley Fiona, Wooster Margaux E, Faheem Khadija F, Varoli Andrew, McGuinness Julia E, Vasan Neil, Trivedi Meghna S, Crew Katherine D, Harden Erik, Law Cynthia, Hershman Dawn L, Accordino Melissa K
Vagelos College of Physicians and Surgeons, Columbia University Medical Center, New York, NY, USA.
Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA.
Breast Cancer Res Treat. 2025 Aug;212(3):511-519. doi: 10.1007/s10549-025-07745-z. Epub 2025 Jun 4.
Diabetes (DM) and hyperglycemia during chemotherapy increase the risk of toxicity, yet the prevalence and patterns of hyperglycemia in early-stage breast cancer (ESBC) patients undergoing chemotherapy with concurrent dexamethasone remain poorly understood.
We conducted a prospective single-arm study using FreeStyle Libre Pro continuous glucose monitoring in patients with ESBC receiving chemotherapy from 12/2020-2/2022. Sensors measured interstitial glucose every 15 min and were reapplied every 2-3 weeks. Primary endpoints were (1) prevalence of hyperglycemia (≥ 1 reading ≥ 140 mg/dL), and (2) for those with hyperglycemia, the proportion of time spent hyperglycemic. Secondary endpoints included baseline glucose tolerance by A1c, changes in glucose-related biomarkers, and changes in patient-reported neuropathy, quality of life, and fatigue. Analysis was stratified by baseline A1c (euglycemic < 5.7%, prediabetes [pre-DM] 5.7-6.4%, diabetes [DM] ≥ 6.5%).
Among 20 evaluable patients (median age: 60, BMI: 29.5 kg/m), common chemotherapy regimens included docetaxel/cyclophosphamide (25%), paclitaxel/trastuzumab (20%), paclitaxel then doxorubicin/cyclophosphamide (15%), docetaxel/carboplatin/trastuzumab/pertuzumab (15%), and cyclophosphamide/methotrexate/fluorouracil (15%). All patients received Dexamethasone. At baseline, 10 patients were euglycemic, 7 had pre-DM, and 3 had DM. All experienced hyperglycemia. Of 124,165 total glucose readings, 17% were ≥ 140 mg/dL. By cohort, the proportion of time spent hyperglycemic was 3.9% (euglycemic), 10% (pre-DM), and 73.3% (DM) (p < .0001). Mean glucose values were 95.5 mg/dL (euglycemic), 104.5 mg/dL (pre-DM), and 183.0 mg/dL (DM) (p < .0001).
All patients receiving chemotherapy for ESBC experienced hyperglycemia, with time spent hyperglycemic varying significantly by baseline A1c. Future research should explore approaches to and benefits of improving glycemic control during treatment in patients with baseline dysglycemia.
NCT04473378.
化疗期间的糖尿病（DM）和高血糖会增加毒性风险，但对于接受化疗并同时使用地塞米松的早期乳腺癌（ESBC）患者，高血糖的患病率和模式仍知之甚少。
我们进行了一项前瞻性单臂研究，对2020年12月至2022年2月接受化疗的ESBC患者使用FreeStyle Libre Pro连续血糖监测。传感器每15分钟测量一次组织间液葡萄糖，每2至3周重新应用一次。主要终点为：（1）高血糖的患病率（≥1次读数≥140mg/dL），以及（2）对于高血糖患者，高血糖状态持续的时间比例。次要终点包括根据糖化血红蛋白（A1c）评估的基线糖耐量、血糖相关生物标志物的变化，以及患者报告的神经病变、生活质量和疲劳的变化。分析按基线A1c分层（血糖正常<5.7%，糖尿病前期[pre-DM]5.7-6.4%，糖尿病[DM]≥6.5%）。
在20例可评估患者中（中位年龄：60岁，体重指数：29.5kg/m²），常见化疗方案包括多西他赛/环磷酰胺（25%）、紫杉醇/曲妥珠单抗（20%）、先使用紫杉醇然后使用阿霉素/环磷酰胺（15%）、多西他赛/卡铂/曲妥珠单抗/帕妥珠单抗（15%），以及环磷酰胺/甲氨蝶呤/氟尿嘧啶（15%）。所有患者均接受地塞米松治疗。基线时，10例患者血糖正常，7例有糖尿病前期，3例有糖尿病。所有患者均出现高血糖。在总共124165次血糖读数中，17%≥140mg/dL。按队列划分，高血糖状态持续的时间比例分别为3.9%（血糖正常）、10%（糖尿病前期）和73.3%（糖尿病）（p<0.0001）。平均血糖值分别为95.5mg/dL（血糖正常）、104.5mg/dL（糖尿病前期）和183.0mg/dL（糖尿病）（p<0.0001）。
所有接受ESBC化疗的患者均出现高血糖，高血糖状态持续的时间因基线A1c不同而有显著差异。未来的研究应探索改善基线血糖异常患者治疗期间血糖控制的方法及其益处。
NCT04473378。
