Oncology Today with Dr Neil Love Diabetology in Breast Cancer — Managing Hyperglycemia in Patients with Breast Cancer Receiving Agents Targeting the PI3K/AKT/PTEN Pathway
Mar 28, 2026
Professor Giuseppe Curigliano, oncology professor with international trial experience; Dr Hope S Rugo, medical oncologist experienced in breast cancer therapeutics; Dr Marie E McDonnell, endocrinologist specializing in diabetes in cancer patients. They discuss hyperglycemia linked to PI3K/AKT/PTEN inhibitors. Topics include continuous glucose monitoring, steroid-related spikes, timing and incidence of drug-induced hyperglycemia, and practical monitoring plus management strategies.
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Screen Prediabetes Before Steroids Or PI3K Drugs
- Warn patients with prediabetes (A1C 5.7–6.4) they often develop steroid‑induced or drug‑related hyperglycemia and consider proactive monitoring.
- Marie E McDonnell: High‑dose dexamethasone commonly unmasks hyperglycemia in patients previously labeled as prediabetic.
Elderly Patient Had Sudden Severe Hyperglycemia When Sick
- A 79‑year patient with normal A1C (5.4) on capivasertib developed fever and diarrhea then glucose 461 and required ED care, insulin, and metformin.
- Hope S Rugo: Holding the drug during illness and re‑starting at reduced dose plus metformin allowed a year of disease control.
Have Patients Hold Drug When Ill
- Instruct patients to hold PI3K/AKT pathway drugs and seek care if they develop fever, diarrhea, or feel unwell to avoid severe hyperglycemia or DKA.
- Hope S Rugo: Patient who developed fever/diarrhea jumped from normal glucose to 461 and required ED hydration and insulin after holding drug promptly.