Additional Advances in PI3K Inhibitor Research and Clinical Trials: Staying Ahead of Hyperglycemia and Rash Management With Janie Metsker, RN, BSN, CN-BN

Phosphatidylinositol-3-kinase (PI3K) inhibitors are effective treatment for patients with breast cancer but can be associated with significant hyperglycemia and rash. In this interview from the 48th Annual Oncology Nursing Society (ONS) Congress, Janie Metsker, RN, BSN, CN-BN, Clinical Coordinator at St. Luke’s Koontz Center for Advanced Breast Cancer, shares updated strategies for managing these toxicities in order to provide the best outcomes for patients with breast cancer receiving PI3K inhibitors.  

Oncology Data Advisor: Welcome to Oncology Data Advisor. Today, we are here at ONS Congress, and I’m joined by Janie Metsker. Thank you so much for coming on today.

Janie Metsker, RN, BSN, CN-BN: Thank you for having me.

Oncology Data Advisor: It’s nice to finally meet you in person. I know we’ve done a couple of virtual interviews before, so this is great.

Ms. Metsker: Yes, it’s nice to meet you as well, and your team.

Oncology Data Advisor: Would you like to start off by introducing yourself and what you do?

Ms. Metsker: Yes, I’m Janie Metsker. I’m the Clinical Coordinator at St. Luke’s Koontz Center for Advanced Breast Cancer in Kansas City. I navigate patients involved in all aspects of care. I also organize and coordinate our metastatic breast cancer retreats that we do annually. We do one for couples, and then we do one for singles with a support person. That’s a big passion of mine, actually. That’s my role.

Oncology Data Advisor: That’s great. So, you presented a poster here titled Updates on the Management of Hyperglycemia and Rash Associated with PI3K Inhibitors. Going back to a bit of background, what makes these two adverse events so challenging to manage?

Ms. Metsker: I think the thing that makes them challenging is that they are prevalent. They can be difficult to manage and, ultimately for the patient, difficult to live with. They can also be somewhat dangerous. But we need to manage the side effects to help the patient to stay on treatment. I think the most important part of the management of these side effects is that they are manageable. The thing that’s really key with alpelisib, which is what we presented today, is that they are manageable. They are treatable, and they are reversible. To keep patients on treatment is really the goal so that they don’t have to stop treatment just because they’re having these adverse events.

Oncology Data Advisor: What were the updates that you found in how these are managed?

Ms. Metsker: Some of the updates included the escalation of antihistamines that are used for treating rash. Then in the hyperglycemia aspect of it, there are some new data out from the phase 2 METALLICA trial, showing prophylactic metformin use. There are patients who we consider prediabetic, whose hemoglobin A1C is between 5.7% and 6.4%. Maybe they have one or more of the risk factors of being 70 or older, being obese, or having some of those types of things that are the risk factors for hyperglycemia. Metformin can really be of prophylactic use of for those patients. It can be very important.

Oncology Data Advisor: For nurses who aren’t in attendance this year, is there any important info about this that they could take home and start to use in their practices?

Ms. Metsker: I think the take-home to me that has to do with these novel therapies that have been developed for metastatic breast cancer, that we’ve seen come out in the last seven to eight years or so, is patient education, especially for alpelisib. For nurses to be involved in patient education—giving the patients the information they need and telling them what to expect, when to expect it, and when they need to call and report those side effects—is very important. That’s the first thing: patient education.

I think the second thing is prevention and prophylactic treatment. Our poster today was on hyperglycemia and rash. One of the things is to start that non-sedating antihistamine to prevent rash in all patients. Then, like I’ve said, some of the things to be preventative with hyperglycemia, really in all patients, include suggesting and getting them to understand or start a low-carbohydrate diet. They can even start a ketogenic diet. We can be prophylactic and preventative and try to intervene much sooner.

Then the third thing would be for nurses to understand how to assess when the patient calls over the phone. A lot of the time, this is going to be a phone call from the patient about what their blood sugar was that morning or the rash that came up overnight. It’s important to understand how to evaluate that and knowing which information is important to get from the patient. Then, they can use that grading scale of grades 1, 2, 3, and 4 to get an accurate assessment and be able to talk with their providers to get those interventions in a timely fashion.

Oncology Data Advisor. Great. So, how are you enjoying your time at ONS Congress this year?

Ms. Metsker: Oh, it’s great. It’s been a lot of fun, there’s a lot of energy here. I’ve had a lot of fun with some friends and catching up with other nurses. There are 3,000 nurses—what can go wrong, right?

Oncology Data Advisor: Awesome. Well, it was great meeting you. Thanks so much for stopping by today.

Ms. Metsker: Oh, you’re welcome. Thanks for having me.

About Ms. Metsker

Janie Metsker, RN, BSN, CN-BN, is the Clinical Coordinator at the Koontz Center for Advanced Breast Cancer at St. Luke’s Hospital in Kansas City, Missouri. As a Nurse Navigator, Ms. Metsker provides support for patients with newly diagnosed and metastatic breast cancer throughout the course of their diagnosis, treatment, and survivorship. In addition, she coordinates two annual retreats for patients with breast cancer and their support systems.

For More Information

Metsker J & Fulgham P (2023). Updates on the management of hyperglycemia and rash associated with phosphatidylinositol-3-kinase inhibitors from the nursing perspective. Presented at 48th Annual Oncology Nursing Society Congress. Available at:

Transcript edited for clarity. Any views expressed above are the speaker’s own and do not necessarily reflect those of Oncology Data Advisor. 

Related Articles


Your email address will not be published. Required fields are marked *