Unexpected Benefit from Alpelisib and Fulvestrant in a Woman with Highly Pre-treated ER-Positive, HER2-Negative PIK3CA Mutant Metastatic Breast Cancer
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We present the case of a postmenopausal patient with a secondary metastatic ER-positive, HER2-negative breast cancer who was successfully treated with fulvestrant and alpelisib following six lines of therapy. The tumour showed two uncommon PIK3CA mutations, and with the combination of alpelisib and fulvestrant the patient went from ECOG grade 3, before the start of this therapy, to ECOG grade 1 during treatment until progressive disease after 6 months. This unexpected benefit emphasizes the importance of performing a Next Generation Sequencing (NGS)-based assay to screen for several cancer genes in the metastatic setting, even after more than four lines of therapy and a high ECOG grade. Moreover, the use of alpelisib may be beneficial for uncommon PIK3CA mutations.
GH, LS and LJ wrote the manuscript. IVB and SVB were responsible for the NGS analysis and interpretation of the results. TM evaluated the radiological images. All authors participated in supervision and manuscript editing. All authors read and approved the final manuscript.
Compliance with Ethical Standards
Ethics approval and consent to participate
The study was conducted in compliance with the principles of the Declaration of Helsinki (2008), the principles of GCP and in accordance with all applicable regulatory requirements. The study was approved by our Ethics Committee and the patient gave written informed consent.
Consent for publication
The patient gave written consent for publication.
Conflict of interest
The authors declare that they have no competing interests.
Novartis Belgium provided the patient with free samples of BYL-179 (oral alpelisib) and AstraZeneca Belgium provided fulvestrant.
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