Oncology Brothers: Practice-Changing Cancer Discussions Managing Toxicities of PI3K & AKT Inhibitors in Breast Cancer – Drs. Emily Gallagher & Neil Iyengar
Dec 11, 2025
In this enlightening discussion, Dr. Emily Gallagher, an endocrinologist focused on metabolic complications of cancer therapy, joins Dr. Neil Iyengar, a breast medical oncologist specializing in targeted therapies. They dive into the nuances of PI3K and AKT inhibitors for hormone receptor-positive metastatic breast cancer. Listeners will learn about the management of common side effects like hyperglycemia and gastrointestinal issues, practical dosing strategies, and the critical role of patient education in ensuring effective treatment.
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Efficacy Comes With Predictable Class Toxicities
- Inavolisib and other PI3K/AKT inhibitors bring clear survival benefits but carry class toxicities like hyperglycemia, rash, and diarrhea.
- Clinicians must balance efficacy with nuanced toxicity management to keep patients on therapy.
Start Metformin Low And Early
- Start metformin early for high-risk patients and titrate slowly from 500 mg once daily to reduce GI side effects.
- Use extended-release metformin and always advise taking it with food to improve tolerance.
Target High BMI Patients Proactively
- Patients with BMI >30 have higher hyperglycemia risk, so proactively offer metformin and dietary counseling.
- Focus counseling on reducing refined carbohydrates rather than calorie restriction in advanced cancer.