Fig. 1: Consensus treatment algorithm for the management of the first episode of hyperglycemia associated with alpelisib. | npj Breast Cancer

Fig. 1: Consensus treatment algorithm for the management of the first episode of hyperglycemia associated with alpelisib.

From: Managing hyperglycemia and rash associated with alpelisib: expert consensus recommendations using the Delphi technique

Fig. 1

ALP alpelisib, FBG fasting blood glucose, HbA1c glycosylated hemoglobin, MTD maximum-tolerated dose, ULN upper limit of normal. aUnless otherwise stated for all statements about increasing metformin, assume extended-release or short-acting, and up to MTD. bIn certain circumstances (e.g., select patients who continue to have HbA1c < 8.0% or those who are asymptomatic and intolerant to metformin), it may be appropriate to continue ALP without initiating or changing metformin dose. cIt may also be appropriate to temporarily hold ALP (with the intent to restart at same dose) and increase metformin in certain high-risk patients (e.g., HbA1c > 5.7%). dIf FBG > 250 to ≤500 mg/dL, it may also be appropriate to hold or dose reduce ALP without first holding and continue metformin without a dose increase (metformin not at MTD) while simultaneously initiating a second agent. eWith the goal of titrating to maximum dose of 2000 mg/day within 1 week32. fIf FBG > ULN to ≤250 mg/dL, it may also be appropriate to either (1) continue ALP while simultaneously initiating metformin and a second agent or, (2) hold ALP while simultaneously initiating metformin and a second agent in certain high-risk patients (e.g., HbA1c ≥ 6.5%).

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