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Randomized Controlled Trial
. 2021 Apr 1;27(7):1842-1849.
doi: 10.1158/1078-0432.CCR-20-3652. Epub 2020 Nov 9.

FDA Approval Summary: Alpelisib Plus Fulvestrant for Patients with HR-positive, HER2-negative, PIK3CA-mutated, Advanced or Metastatic Breast Cancer

Preeti Narayan  1 , Tatiana M Prowell  2 , Jennifer J Gao  2   3 , Laura L Fernandes  2 , Emily Li  4 , Xiling Jiang  2 , Junshan Qiu  2 , Jianghong Fan  2 , Pengfei Song  2 , Jingyu Yu  2 , Xinyuan Zhang  2 , Bellinda L King-Kallimanis  2 , Wei Chen  2 , Tiffany K Ricks  2 , Yutao Gong  2 , Xing Wang  2 , Katherine Windsor  2 , Steve Y Rhieu  2 , Gerlie Geiser  2 , Anamitro Banerjee  2 , Xiaohong Chen  2 , Francisca Reyes Turcu  5 , Deb K Chatterjee  5 , Anand Pathak  5 , Jeffrey Seidman  5 , Soma Ghosh  5 , Reena Philip  5 , Kirsten B Goldberg  2   3 , Paul G Kluetz  2   3 , Shenghui Tang  2 , Laleh Amiri-Kordestani  2 , Marc R Theoret  2   3 , Richard Pazdur  2   3 , Julia A Beaver  2   3
Affiliations
Randomized Controlled Trial

FDA Approval Summary: Alpelisib Plus Fulvestrant for Patients with HR-positive, HER2-negative, PIK3CA-mutated, Advanced or Metastatic Breast Cancer

Preeti Narayan et al. Clin Cancer Res. .

Abstract

On May 24, 2019, the FDA granted regular approval to alpelisib in combination with fulvestrant for postmenopausal women, and men, with hormone receptor (HR)-positive, HER2-negative, phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA)-mutated, advanced or metastatic breast cancer as detected by an FDA-approved test following progression on or after an endocrine-based regimen. Approval was based on the SOLAR-1 study, a randomized, double-blind, placebo-controlled trial of alpelisib plus fulvestrant versus placebo plus fulvestrant. The primary endpoint was investigator-assessed progression-free survival (PFS) per RECIST v1.1 in the cohort of trial participants whose tumors had a PIK3CA mutation. The estimated median PFS by investigator assessment in the alpelisib plus fulvestrant arm was 11 months [95% confidence interval (CI), 7.5-14.5] compared with 5.7 months (95% CI, 3.7-7.4) in the placebo plus fulvestrant arm (HR, 0.65; 95% CI, 0.50-0.85; two-sided P = 0.001). The median overall survival was not yet reached for the alpelisib plus fulvestrant arm (95% CI, 28.1-NE) and was 26.9 months (95% CI, 21.9-NE) for the fulvestrant control arm. No PFS benefit was observed in trial participants whose tumors did not have a PIK3CA mutation (HR, 0.85; 95% CI, 0.58-1.25). The most common adverse reactions, including laboratory abnormalities, on the alpelisib plus fulvestrant arm were increased glucose, increased creatinine, diarrhea, rash, decreased lymphocyte count, increased gamma glutamyl transferase, nausea, increased alanine aminotransferase, fatigue, decreased hemoglobin, increased lipase, decreased appetite, stomatitis, vomiting, decreased weight, decreased calcium, decreased glucose, prolonged activated partial thromboplastin time, and alopecia.

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Conflict of interest statement

Disclosure of Potential Conflicts of Interest: The authors report no financial interests or relationships with the commercial sponsors of any products discussed in this report.

Figures

Figure 1:
Figure 1:
Chemical Structure of Alpelisib (8)
Figure 2:
Figure 2:
Kaplan-Meier Plot of Progression-Free Survival in SOLAR-1 (Per Investigator Assessment of Patients with a PIK3CA Tumor Mutation)(7)
See this image and copyright information in PMC

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