Elacestrant plus alpelisib in an ESR1 and PIK3CA co-mutated and heavily pretreated metastatic breast cancer: the first case report for combination efficacy and safety
Therapeutic Advances in Medical Oncology, vol.16, 2024 (SCI-Expanded, Scopus)
- Publication Type: Article / Article
- Volume: 16
- Publication Date: 2024
- Doi Number: 10.1177/17588359241297101
- Journal Name: Therapeutic Advances in Medical Oncology
- Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus, Directory of Open Access Journals
- Keywords: alpelisib, cancer genomics, case report, elacestrant, ESR1/PIK3CA co-mutations, HR-positive/HER2-negative metastatic breast cancer, selective estrogen receptor degrader (SERD)
- Istanbul University Affiliated: No
Abstract
Breast cancer (BC) is the leading cause of cancer-related mortality among women, and hormone receptor (HR)-positive subtype makes up the majority of all cases. The standard of care in HR+/HER2− metastatic BC (MBC) is endocrine therapy (ET) plus a CDK4/6 inhibitor (CDK4/6i). ESR1 mutations could impair the clinical efficacy of the ETs. Similarly, PIK3CA mutations may serve as a negative prognostic marker. Furthermore, MBC is challenging to treat despite new drug approvals. Our patient received multiple lines of ET ± CDK4/6i and chemotherapy but persistently progressed after each or stopped the treatment due to adverse events. Here we showed for the first time that an all-oral combination of elacestrant plus alpelisib was feasible, tolerable, and clinically active in an ESR1 and PIK3CA co-mutated and heavily pretreated patient. We achieved a remarkable response in the metastatic lesions with minor toxicity issues. This case highlights the importance of utilizing up-to-date therapeutic agents and reactive decision-making during personalized cancer treatment.