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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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A Correction to this article was published on 12 January 2019

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Abstract

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.

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Authors and Affiliations

  1. Department of Gynaecology and Obstetrics, University Hospitals Leuven, KU Leuven, University of Leuven, Herestraat 49, 3000, Louvain, Belgium

    Griet Hoste, Johan Menten & Patrick Neven

  2. Department of Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium

    Laurence Slembrouck, Lynn Jongen, Kevin Punie, Hans Wildiers & Patrick Neven

  3. Department of General Medical Oncology, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium

    Kevin Punie & Hans Wildiers

  4. Department of Radiology, KU Leuven, University Hospitals Leuven, 3000, Louvain, Belgium

    Tom Matton & Giuseppe Floris

  5. Department of Pathology, KU Leuven, University Hospitals Leuven, 3000, Louvain, Belgium

    Sara Vander Borght

  6. Department of Human Genetics, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium

    Sara Vander Borght & Isabelle Vanden Bempt

  7. Department of Radiotherapy, University Hospitals Leuven, KU Leuven, University of Leuven, 3000, Louvain, Belgium

    Johan Menten

  8. Department of Imaging and Pathology, Laboratory of Translational Cell and Tissue Research, KU Leuven, University of Leuven, 3000, Louvain, Belgium

    Giuseppe Floris

  9. University of Texas Southwestern Medical Center, Simmons Comprehensive Cancer Center, Dallas, TX, USA

    Carlos Arteaga

Authors
  1. Griet Hoste
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  2. Laurence Slembrouck
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  3. Lynn Jongen
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  4. Kevin Punie
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  5. Tom Matton
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  6. Sara Vander Borght
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  7. Isabelle Vanden Bempt
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  8. Johan Menten
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  9. Hans Wildiers
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  10. Giuseppe Floris
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  11. Carlos Arteaga
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  12. Patrick Neven
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Contributions

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.

Corresponding author

Correspondence to Griet Hoste.

Ethics declarations

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.

Funding

Novartis Belgium provided the patient with free samples of BYL-179 (oral alpelisib) and AstraZeneca Belgium provided fulvestrant.

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Hoste, G., Slembrouck, L., Jongen, L. et al. Unexpected Benefit from Alpelisib and Fulvestrant in a Woman with Highly Pre-treated ER-Positive, HER2-Negative PIK3CA Mutant Metastatic Breast Cancer. Clin Drug Investig 38, 1071–1075 (2018). https://doi.org/10.1007/s40261-018-0696-3

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  • DOI: https://doi.org/10.1007/s40261-018-0696-3

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