Published in Practice Update 17 June 2020.Since the publication...

Published in Practice Update 17 June 2020.
Since the publication of SOLAR-1, we have incorporated the use of alpelisib into our patients with hormone receptor-positive HER2-negative breast cancer, which is the largest subgroup of metastatic breast cancer patients we see. It's a quite large subgroup. The first thing we do is: we're testing every metastatic breast cancer patient with a comprehensive genomic profile to pick up mutations, such as PIK3CA, because there are now drugs that actually work in these settings. If we know ahead of time, that a patient has a PIK3CA mutation that is likely to be impacted by Alpelisib, we'll typically give first line therapy with a CDK4/6 inhibitor and endocrine therapy. Then, as per SOLAR-1, and now by the BYLieve trial, which gives us greater comfort that patients who have previously been exposed to CDK inhibitors actually do get benefit from alpelisib and fulvestrant, that has become my standard second-line therapy for patients who have this mutation.ASCO: Alpelisib Plus Fulvestrant for PIK3CA-Mutated Breast Cancer After Failure of CDK4/6 Inhibitors


" We understand that the PI 3-kinase pathway is very important in breast cancer. Mutations in the PIK3CA gene are found in about 40% of patients with metastatic hormone receptor-positive HER2-negative breast cancer. Alpelisib is an alpha-specific inhibitor of PIK3CA and has been previously shown, in a phase III trial called SOLAR-1, to have benefit in patients when combined with fulvestrant as a combination therapy in patients with hormone receptor-positive HER2-negative breast cancer, who had previously received endocrine therapy. In that study, we saw about a doubling in the progression-free survival to 11 months from about 5.5 months with the addition of alpelisib compared to fulvestrant alone. One of the concerns about SOLAR-1, which was clearly a breakthrough in terms of this population of patients, targeted therapy based on mutations being identified in this large subgroup of breast cancer patients."

https://www.practiceupdate.com/content/asco-alpelisib-plus-fulvestrant-for-pik3ca-mutated-breast-cancer-after-failure-of-cdk46-inhibitors/102111/15/13/3

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Their is a very good chance Dr P Brastianos can achieve similar results with Paxalisib in the Alliance Trial.

Regards.