Capivasertib Break May Be Needed in Patients With Breast Cancer Experiencing Hyperglycemia

Oncology nurses and advanced practice providers (APPs) should not hesitate to advise patients with breast cancer taking capivasertib (Truqap) to hold off on taking medication on days when oncology specialists may not be available to provide guidance, especially when a changed diet could spike glucose levels, such as holiday weekends, according to Hope Rugo, MD.

Rugo, the division chief of breast medical oncology at City of Hope in Duarte, California, explained in an interview at the 24^th Annual International Congress on the Future of Breast Cancer® East, hosted by Physicians’ Education Resource® (PER), LLC, that hyperglycemia should be taken into consideration when treating patients with breast cancer using an AKT inhibitor like capivasertib.

Patients should receive a hemoglobin A1C and a fasting glucose where applicable, and nurses and APPs should also draw on knowledge of a patient’s body mass index and diet when taking actions to prevent hyperglycemia.

Rugo added that when patients’ glucose levels increase, metformin (Glucophage) can be used to manage hyperglycemia. In cases where a patient’s hemoglobin unexpectedly spikes, Rugo mentioned that a brief break from treatment may be necessary while the patient’s levels return to normal.

Additionally, Rugo said that nurses and APPs should advise patients that if they are not feeling well, especially if they cannot reliably contact their usual nurses and providers, they should feel comfortable skipping a day or 2 of capivasertib with the hope of avoiding exacerbation of a rising glucose level.

Transcript

We’re generally using capivasertib first. When patients have a prior history of hyperglycemia, [that should be taken into consideration] but most patients aren’t coming in and telling you they have borderline glucose control. You need a hemoglobin A1C, you need a fasting glucose. You need to understand body mass index and diet for these patients. Regardless of which drug you’re choosing, manage this proactively. It’s important.

Hemoglobin A1C can be used more liberally when you’re starting capivasertib, and you don’t get that immediate hyperglycemia that we used to see with alpelisib (Piqray). That’s good, but if a patient’s glucose goes up, you want to be more heavy-handed on using Glucophage as an initial approach to try and keep the glucose under a manageable level. I found that patients did very well if they needed it, but very few patients needed a drug.

If a patient has an infection or isn’t feeling good, education is critical with capivasertib and all the drugs that cause hyperglycemia, because they won’t have had a high glucose before. Their glucose is normal. Then they get sick, and the glucose could go up even if they have normal glycemic control.

Now for patients, I’m encouraging people to tell them, “If you don’t feel good, don’t take the dose that evening. Call in in the morning.” It’s such an easy management strategy, because [otherwise] they take the dose, they call in, somebody calls them back, then they go to the emergency department and check their labs, and their glucose level is 300 mg/dL.

One of my patients had a glucose level of 491 mg/dL, and we still don’t know why. On Monday, her glucose was normal. She’d been on [capivasertib] for 8 weeks. It was around a holiday night, so she probably was eating a very different diet, and maybe she had some infection that we didn’t find, and her glucose was high. She did not have diabetic ketoacidosis. We put her on Glucophage, held the drug [capivasertib] and her glucose became normal. We eventually restarted her on a dose reduction of capivasertib after a few days, and she didn’t need the Glucophage anymore.

It’s interesting that the management has to be very individualized, but you have to think ahead and tell people, “Don’t take your drug if you don’t feel good.” What does it hurt to not take the drug for 2 or 3 days, particularly if it might be a holiday? You’ll have trouble reaching people, and the people who are available to answer the patient’s call in clinic may not know the drug well. Education like that is important.

This transcript has been edited for clarity and conciseness.