Hyperglycemia Risk Assessment in PIK3CA-Mutated HR+/HER2-Negative Advanced Breast Cancer

Dr. Jason Mouabbi discusses strategies for assessing and managing the risk of treatment-related hyperglycemia before initiating therapy for patients with PIK3CA-mutated HR-positive/HER2-negative advanced breast cancer. He emphasizes obtaining a baseline HbA1c to assess glycemic status and identify patients with diabetes or elevated baseline risk. Dr. Mouabbi also highlights the importance of reviewing concomitant medications, particularly those that may contribute to elevated blood glucose levels, and considering whether medication-related risk factors can be addressed before treatment. He discusses providing patients with a glucometer and educating them to monitor fasting blood glucose at home, along with recognizing symptoms associated with hyperglycemia, such as increased thirst, frequent urination, blurred vision, and neuropathic symptoms. For patients with elevated baseline risk, he describes having a low threshold for initiating metformin and emphasizes collaboration with primary care or endocrinology for ongoing diabetes management beyond initial intervention.