Alpelisib is a α-selective phosphatidylinositol 3-kinase (PI3K) inhibitor approved for treatment of postmenopausal women, and men, with hormone receptor positive (HR+), human epidermal growth factor receptor 2 negative (HER2–), PIK3CA-mutated, advanced breast cancer (ABC). Hyperglycemia is a common, on-target adverse effect that impairs treatment efficacy and increases the rate of treatment delays, dose reductions, and discontinuation. Currently, there are no clear guidelines on how to manage hyperglycemia due to alpelisib when metformin is not effective. In this case series, we review 3 subjects with ABC that developed hyperglycemia during alpelisib-fulvestrant therapy and were successfully managed with dietary and pharmacologic interventions. These cases provide anecdotal evidence to support the use of sodium-glucose co-transporter-2 inhibitors (SGLT2i) and very low carbohydrate diets to minimize hyperglycemia during alpelisib therapy.

Alpelisib 是一种 α 选择性磷脂酰肌醇 3-激酶 (PI3K) 抑制剂，被批准用于治疗绝经后女性和男性，激素受体阳性 (HR+)、人表皮生长因子受体 2 阴性 (HER2-)、PIK3CA 突变、晚期乳腺癌癌症（ABC）。高血糖是一种常见的靶向不良反应，会损害治疗效果并增加治疗延迟、剂量减少和停药的发生率。目前，当二甲双胍无效时，如何管理由 alpelisib 引起的高血糖没有明确的指导方针。在这个病例系列中，我们回顾了 3 名在 alpelisib-fulvestrant 治疗期间出现高血糖并通过饮食和药物干预成功控制的 ABC 受试者。