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

Dr. Jason Mouabbi discusses the approach to managing treatment-related hyperglycemia while maintaining cancer treatment for patients with PIK3CA-mutated HR-positive/HER2-negative advanced breast cancer. He emphasizes grading hyperglycemia to guide intervention and describes initial management of lower-grade elevations with dietary modification, hydration, and consideration of metformin while continuing anticancer therapy. As glucose levels increase into Grade 2 hyperglycemia, Dr. Mouabbi explains the importance of temporarily holding inavolisib until glucose improves before resuming treatment. He also highlights the role of primary care or endocrinology in managing more clinically significant hyperglycemia and determining whether additional antihyperglycemic treatment is needed. The discussion underscores the importance of early intervention and multidisciplinary collaboration, allowing the oncology team to address treatment-related glucose elevations while maintaining the broader goals of cancer treatment.