Managing hyperglycemia and rash associated with alpelisib: expert consensus recommendations using the Delphi technique
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 r...
| Main Authors: | , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Nature Portfolio
2024-01-01
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| Series: | npj Breast Cancer |
| Online Access: | https://doi.org/10.1038/s41523-024-00613-x |
| _version_ | 1827326654308941824 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Emily J. Gallagher |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-03-07T14:48:42Z |
| format | Article |
| id | doaj.art-8183fb8cce4340f9881e7c5f5b6eef4c |
| institution | Directory Open Access Journal |
| issn | 2374-4677 |
| language | English |
| last_indexed | 2024-03-07T14:48:42Z |
| publishDate | 2024-01-01 |
| publisher | Nature Portfolio |
| record_format | Article |
| series | npj Breast Cancer |
| spelling | doaj.art-8183fb8cce4340f9881e7c5f5b6eef4c2024-03-05T19:50:26ZengNature Portfolionpj Breast Cancer2374-46772024-01-0110111110.1038/s41523-024-00613-xManaging hyperglycemia and rash associated with alpelisib: expert consensus recommendations using the Delphi techniqueEmily J. Gallagher0Heather Moore1Mario E. Lacouture2Susan F. Dent3Azeez Farooki4Marcus D. Goncalves5Claudine Isaacs6Abigail Johnston7Dejan Juric8Zoe Quandt9Laura Spring10Brian Berman11Melanie Decker12Gabriel N. Hortobagyi13Benjamin H. Kaffenberger14Bernice Y. Kwong15Timothy Pluard16Ruta Rao17Lee Schwartzberg18Michael S. Broder19Division of Endocrinology, Diabetes and Bone Disease, Department of Medicine, and Tisch Cancer Institute, Icahn School of Medicine at Mount SinaiDuke Cancer Institute, Duke UniversityDepartment of Medicine, Memorial Sloan Kettering Cancer CenterDuke Cancer Institute, Duke UniversityDepartment of Medicine, Memorial Sloan Kettering Cancer CenterDivision of Endocrinology, Weill Department of Medicine, Weill Cornell MedicineLombardi Comprehensive Cancer Center, Georgetown UniversitySurviving Breast Cancer, 305 Pink PackMassachusetts General Hospital Cancer Center, Department of Medicine, Harvard Medical SchoolSchool of Medicine, University of CaliforniaMassachusetts General Hospital Cancer Center, Department of Medicine, Harvard Medical SchoolUniversity of Miami School of Medicine and Center for Clinical and Cosmetic ResearchWoodland Memorial Hospital, Woodland, CA, and Kaiser PermanenteDepartment of Breast Medical Oncology, The University of Texas MD Anderson Cancer CenterWexner Medical Center, The Ohio State UniversityDepartment of Dermatology, Stanford University School of MedicineSt. Luke’s Hospital Koontz Center for Advanced Breast CancerRush Hematology, Oncology and Cell Therapy, Rush University Medical CenterWest Cancer CenterPHARAbstract 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.https://doi.org/10.1038/s41523-024-00613-x |
| spellingShingle | 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 Managing hyperglycemia and rash associated with alpelisib: expert consensus recommendations using the Delphi technique npj Breast Cancer |
| title | Managing hyperglycemia and rash associated with alpelisib: expert consensus recommendations using the Delphi technique |
| title_full | Managing hyperglycemia and rash associated with alpelisib: expert consensus recommendations using the Delphi technique |
| title_fullStr | Managing hyperglycemia and rash associated with alpelisib: expert consensus recommendations using the Delphi technique |
| title_full_unstemmed | Managing hyperglycemia and rash associated with alpelisib: expert consensus recommendations using the Delphi technique |
| title_short | Managing hyperglycemia and rash associated with alpelisib: expert consensus recommendations using the Delphi technique |
| title_sort | managing hyperglycemia and rash associated with alpelisib expert consensus recommendations using the delphi technique |
| url | https://doi.org/10.1038/s41523-024-00613-x |
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