Managing hyperglycemia and rash associated with alpelisib: expert consensus recommendations using the Delphi technique

Emily J. Gallagher, Heather Moore, Mario E. Lacouture, Susan F. Dent, Azeez Farooki, Marcus D. Goncalves, Claudine Isaacs, Abigail Johnston, Dejan Juric, Zoe Quandt, Laura Spring, Brian Berman, Melanie Decker, Gabriel N. Hortobagyi, Benjamin H. Kaffenberger, Bernice Y. Kwong, Timothy Pluard, Ruta Rao, Lee Schwartzberg, Michael S. Broder

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Hyperglycemia and rash are expected but challenging adverse events of phosphatidylinositol-3-kinase inhibition (such as with alpelisib). Two modified Delphi panels were conducted to provide consensus recommendations for managing hyperglycemia and rash in patients taking alpelisib. Experts rated the appropriateness of interventions on a 1-to-9 scale; median scores and dispersion were used to classify the levels of agreement. Per the hyperglycemia panel, it is appropriate to start alpelisib in patients with HbA1c 6.5% (diabetes) to <8%, or at highest risk for developing hyperglycemia, if they have a pre-treatment endocrinology consult. Recommend prophylactic metformin in patients with baseline HbA1c 5.7% to 6.4%. Metformin is the preferred first-line anti-hyperglycemic agent. Per the rash panel, initiate prophylactic nonsedating H1 antihistamines in patients starting alpelisib. Nonsedating H1 antihistamines and topical steroids are the preferred initial management for rash. In addition to clinical trial evidence, these recommendations will help address gaps encountered in clinical practice.

Original languageEnglish
Article number12
Journalnpj Breast Cancer
Volume10
Issue number1
DOIs
StatePublished - Dec 2024

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