Breast cancer (invasive) · line 2 · Capivasertib + fulvestrant (HR+/HER2- PIK3CA/AKT1/PTEN-altered metastatic post-AI/CDK4/6i)
Deterministic view of the source YAML entity. Clinical authority remains with the cited source IDs and reviewer sign-off state.
Knowledge-base record for audit. Provisional clinical content: this is not a prescription. An oncologist must verify original sources, applicability and review status. Full rules and constraints are in the YAML.
| Line of therapy | 2 |
|---|---|
| Track | standard |
| Linked regimen | REG-CAPIVASERTIB-FULVESTRANT-BREAST |
| ID | IND-BREAST-HR-POS-2L-AKT-CAPIVASERTIB |
|---|---|
| Type | Indication |
| Status | reviewed 2026-04-27 | pending_clinical_signoff |
| Diseases | DIS-BREAST |
| Sources | SRC-CAPITELLO291-TURNER-2023 SRC-ESMO-BREAST-METASTATIC-2024 SRC-NCCN-BREAST-2025 |
Notes
ESCAT IA. CAPItello-291 established capivasertib + fulvestrant for HR+/HER2- with PIK3CA / AKT1 / PTEN alteration after AI ± CDK4/6i progression. Broader biomarker coverage than alpelisib (which gates only on PIK3CA): pathway-altered cohort enriched ~41% of ITT. Diarrhea (72%) management dominant workflow burden — loperamide on hand from day 1, intermittent 4-on/3-off dosing intentionally improves tolerability. UA access barrier: capivasertib not yet registered; named-patient import / EAP only. PTEN-loss definition operationally requires combined IHC + NGS (per CAPItello enrolment criteria). When both PIK3CA-mut and AKT1/PTEN coexist, capivasertib is preferred over alpelisib for pathway-spectrum coverage and intermittent-dosing tolerability.
Used By
Algorithms
ALGO-BREAST-HR-POS-2L- ALGO-BREAST-HR-POS-2L
Handbook Chapters
HB-BREAST-HR-POS-HER2-NEG-1L- HR+/HER2- metastatic breast cancer: first-line reasoning