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Alpelisib PIK3CA — SCE Medical Oncology MCQ

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ModerateBreast CancerAlpelisib PIK3CASCE Medical Oncology

A 60-year-old woman with metastatic ER+/HER2- breast cancer on first-line AI + palbociclib develops progressive disease. Her ctDNA shows an acquired PIK3CA H1047R mutation. What targeted therapy is relevant?

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Correct answer: D — Alpelisib (PI3Kα inhibitor) + fulvestrant

PIK3CA mutations drive endocrine resistance. Alpelisib + fulvestrant showed significant PFS benefit in PIK3CA-mutant MBC (SOLAR-1). Key toxicity: hyperglycaemia requiring metformin co-administration.

Reference: https://www.nice.org.uk/guidance/conditions-and-diseases/cancer