VIDEO: Hyperglycemia, diarrhea common among breast cancer patients receiving PI3K inhibitors

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The most common comorbidities using PIK3CA inhibitors, are hyperglycemia, diarrhea, and rash. In the SOLAR-1 Study that used Alpelisib, we found that 60% of patients experienced hyperglycemia, And this is despite the exclusion of patients with Type 1 diabetes, and suboptimally controlled Type 2 diabetes.

Our newer PIK3CA inhibitor in Alpelisib, also selected for patients with good hemoglobin A1Cs, however, 60% were found to have hyperglycemia in the study. The Grade 3 and 4 toxicities were lower, around 6%. So overall, this is a side effect that we must monitor with closed monitoring of blood levels, we have to institute aggressive measures in terms of diet, introduce anti-diabetic medications, like metformin or other anti-diabetic drugs, we often collaborate with primary care providers, we even enlist the expertise of endocrinologists when needed to combat this problem.

Another very common side effect is diarrhea, around half the patients in this study have reported diarrhea, which is functionally very limiting. So the use of antidiarrheals, again, requires education and appropriate dose reductions are also introduced to keep these patients on the study.

Other side effects we are, you know, used to seeing while on PIK3CA inhibitors are nausea, vomiting, fatigue, dermatitis, less common side effects like pneumonitis can be potentially life-threatening and important to recognize.

These side effects are extremely impactful because, you know, it can range from deterioration in quality of life, and can also be serious enough, causing dehydration, renal insufficiency, and even hospitalization.

Therefore, again, as providers, we must educate the patient before they start these therapies, we must monitor them very closely, especially in the beginning, introduce supportive measures, appropriately dose-reduce according to the guidelines given to us by these clinical trials, and, you know, really aggressively institute these measures, and these really go a very long way in keeping patients on treatment.