Nicolas Sahakian1, Lauranne Cattieuw1, Clotilde Ramillon-Cury1, Audrey Bégu-Le Corroller1, Pascale Silvestre-Aillaud1, Sophie Béliard1,2, René Valéro3,4,5. 1. Department of Nutrition, Metabolic Diseases and Endocrinology, University Hospital La Conception, 147 boulevard Baille, 13005, Marseille, France. 2. Aix Marseille Univ, APHM, INSERM, INRAE, C2VN, 27 boulevard Jean Moulin, 13005, Marseille, France. 3. Department of Nutrition, Metabolic Diseases and Endocrinology, University Hospital La Conception, 147 boulevard Baille, 13005, Marseille, France. RVALERO@mail.ap-hm.fr. 4. Aix Marseille Univ, APHM, INSERM, INRAE, C2VN, 27 boulevard Jean Moulin, 13005, Marseille, France. RVALERO@mail.ap-hm.fr. 5. Service de Nutrition, Maladies Métaboliques Et Endocrinologie, Centre Hospitalo-Universitaire de La Conception, 147 Boulevard Baille, 13005, Marseille, France. RVALERO@mail.ap-hm.fr.
Abstract
BACKGROUND: Hyperglycemia is the most common side-effect of phosphatidylinositol 3-kinase (PI3K) inhibitors that are approved for the treatment of some advanced or metastatic breast cancers. This side-effect is likely due to the central role of PI3K in insulin signalling. Here we report the use of a sodium-glucose cotransporter 2 (SGLT2) inhibitor to manage severe hyperglycemia. CASE PRESENTATION: We describe a 74-year-old woman who developed severe uncontrolled hyperglycemia after commencing alpelisib, a new oral PI3K inhibitor indicated for a metastatic breast cancer, despite taking oral anti-diabetic drugs, metformin and vildagliptin, combined with intravenous insulin infusion of up to 250 units/day. The introduction of the SGLT2 inhibitor dapagliflozin rapidly improved blood glucose with a drastic reduction in insulin dosage, from 250 to 12 units/day, and without significant side-effects. CONCLUSIONS: We report the successful management of hyperglycemia induced by alpelisib using a SGLT2 inhibitor without the need to discontinue effective cancer treatment.
BACKGROUND:Hyperglycemia is the most common side-effect of phosphatidylinositol 3-kinase (PI3K) inhibitors that are approved for the treatment of some advanced or metastatic breast cancers. This side-effect is likely due to the central role of PI3K in insulin signalling. Here we report the use of a sodium-glucose cotransporter 2 (SGLT2) inhibitor to manage severe hyperglycemia. CASE PRESENTATION: We describe a 74-year-old woman who developed severe uncontrolled hyperglycemia after commencing alpelisib, a new oral PI3K inhibitor indicated for a metastatic breast cancer, despite taking oral anti-diabetic drugs, metformin and vildagliptin, combined with intravenous insulin infusion of up to 250 units/day. The introduction of the SGLT2 inhibitor dapagliflozin rapidly improved blood glucose with a drastic reduction in insulin dosage, from 250 to 12 units/day, and without significant side-effects. CONCLUSIONS: We report the successful management of hyperglycemia induced by alpelisib using a SGLT2 inhibitor without the need to discontinue effective cancer treatment.