Proactive Nursing Care for PI3K and AKT Inhibitor Adverse Effects

Proactive monitoring of diarrhea and hyperglycemia, coupled with early supportive interventions, is essential to helping patients stay on PI3K and AKT inhibitors for breast cancer, according to Kelsey Martin, APRN, AG-ACNP-BC, AOCNP.

In an interview with Oncology Nursing News following her presentation at the 9th Annual School of Nursing Oncology, hosted by Physicians’ Education Resource®, LLC, Martin noted that capivasertib (Truqap) is increasingly favored over alpelisib (Piqray) due to its generally better tolerability, though careful monitoring remains essential for both.

Martin explained that blood glucose elevations and diarrhea are the most common toxicities in this setting, requiring nurses and advanced practice providers (APPs) to have a plan in place. Metformin (Glucophage) can help manage hyperglycemia, she said, but clinicians must weigh its potential to worsen gastrointestinal symptoms. Individualized care, use of supportive medications such as loperamide, and collaboration with endocrinology when needed can help patients remain on treatment.

According to Martin, who is a nurse practitioner at SCRI Oncology Partners, a member of The US Oncology Network, in Nashville Tennessee, nursing vigilance and proactive care are central to optimizing outcomes with PI3K and AKT inhibitors.

Transcript

We tend to use more capivasertib lately because it’s a bit better tolerated than alpelisib. It’s newer, and sometimes the diarrhea can be slightly better. None of them are without adverse effects, but as long as we can [zero] in on it, monitor it quickly, and make changes, we typically don’t have a lot of issues with tolerability.

We’re strict about monitoring blood glucose and intervening when we see diarrhea. Those are typically the biggest things that we see on PI3K inhibitors, so we make sure that we have a plan for those patients. If we need to get endocrinology involved for glucose issues, we certainly can.

One thing we do, which I mentioned in this talk, is metformin is used to help with blood sugar, but, of course, that can cause diarrhea. If someone has both glucose issues and diarrhea, are we fixing one [issue] and making [another] worse? That’s the art of medicine: to try and figure out how to do that best.

I can think of one patient in particular who had a little bit of both diarrhea and glucose issues when we started her [treatment], and now she’s on a stable regimen, where she’s tolerating it very well. She may have some loose stools, but she uses her Imodium and those sorts of things so that she can get the benefit of the drug without being without it being intolerable for her.

Trying to be proactive is the best way to do it. Typically, capivasertib is best tolerated for most of our patients, at least in recent use.

This transcript has been edited for clarity and conciseness.