Managing Hyperglycemia and Rash Associated With Alpelisib: Expert Consensus Recommendations Using the Delphi Technique

Two Delphi panels of experts have provided consensus recommendations for managing hyperglycemia and rash in patients taking alpelisib, a phosphatidylinositol-3-kinase inhibitor. For hyperglycemia, it is recommended to start alpelisib in patients with HbA1c between 6.5% and <8% only after a pre-treatment endocrinology consult, and to use prophylactic metformin for those with HbA1c between 5.7% and 6.4%. Metformin is also the preferred first-line treatment for hyperglycemia. For managing rash, the panel suggests initiating prophylactic nonsedating H1 antihistamines when starting alpelisib and using these antihistamines along with topical steroids as the initial treatment for rash. These recommendations aim to fill the gaps in clinical practice beyond what is provided by clinical trial evidence.