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Background <p>Alpelisib is a selective phosphatidylinositol-3-kinase-α (PI3K-α) inhibitor for treatment of advanced breast cancer,&#xa0;with a known side effect of Alpelisib-induced Hyperglycemia (AIH). We present two cases where AIH occurred&#xa0;despite the absence of classical risk factors.</p> Case presentation <p>Both our patients were women of Malaysian-Chinese descent with advanced breast cancer who have failed first-line&#xa0;therapy. Their BMI were within normal range. Patient A was 38 years old, with prior history of gestational diabetes,&#xa0;and pre-existing pre-diabetes (HbA1c 5.9%). Patient B was 74 years old and had positive family history of type 2&#xa0;diabetes. Both patients developed AIH within a week of starting Alpelisib. Degree of hyperglycemia was dose-dependent.&#xa0;Both patients required multiple oral glucose lowering therapy, and Patient A required additional insulin&#xa0;therapy. Hyperglycemia resolved in both patients after cessation of Alpelisib due to disease progression.</p> Conclusion <p>Ethnicity, prediabetes and GDM has to be considered as risk factors for AIH. Intensive glucose monitoring in patients&#xa0;starting Alpelisib is essential.</p>

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Overlooked risk factors for Alpelisib-induced hyperglycemia amongst Asians: lessons from case vignettes

  • 期刊论文

  • 发表日期：

    2025年4月2日

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  • Quan-Hziung Lim,
  • Anantharaju Ramachandram,
  • Saravanaa Nalliah,
  • Sue-Wen Lim,
  • Jeyakantha Ratnasingam

摘要

Background

Alpelisib is a selective phosphatidylinositol-3-kinase-α (PI3K-α) inhibitor for treatment of advanced breast cancer, with a known side effect of Alpelisib-induced Hyperglycemia (AIH). We present two cases where AIH occurred despite the absence of classical risk factors.

Case presentation

Both our patients were women of Malaysian-Chinese descent with advanced breast cancer who have failed first-line therapy. Their BMI were within normal range. Patient A was 38 years old, with prior history of gestational diabetes, and pre-existing pre-diabetes (HbA1c 5.9%). Patient B was 74 years old and had positive family history of type 2 diabetes. Both patients developed AIH within a week of starting Alpelisib. Degree of hyperglycemia was dose-dependent. Both patients required multiple oral glucose lowering therapy, and Patient A required additional insulin therapy. Hyperglycemia resolved in both patients after cessation of Alpelisib due to disease progression.

Conclusion

Ethnicity, prediabetes and GDM has to be considered as risk factors for AIH. Intensive glucose monitoring in patients starting Alpelisib is essential.