Breast cancer (invasive) · line 2 · Alpelisib + fulvestrant (HR+/HER2- PIK3CA-mutant 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-ALPELISIB-FULVESTRANT-BREAST |
| ID | IND-BREAST-HR-POS-2L-PIK3CA-ALPELISIB |
|---|---|
| Type | Indication |
| Status | reviewed 2026-04-27 | pending_clinical_signoff |
| Diseases | DIS-BREAST |
| Sources | SRC-ESMO-BREAST-METASTATIC-2024 SRC-NCCN-BREAST-2025 SRC-SOLAR1-ANDRE-2019 |
Notes
ESCAT IA. SOLAR-1 established alpelisib + fulvestrant for PIK3CA-mutant HR+/HER2- after AI ± CDK4/6i progression. Hotspots in exons 9 (E542K, E545K, helical) and 20 (H1047R, H1047L, kinase) detected by tissue NGS or ctDNA. Hyperglycemia management dominant workflow burden — pre-treatment HbA1c + fasting glucose; metformin first-line if hyperglycemic. UA access barrier: alpelisib registered but NSZU does not cover; out-of-pocket. CAPItello-291 (capivasertib) is overlapping option for this group plus AKT1/PTEN — see ALGO-BREAST-HR-POS-2L for selection rationale.
Used By
Algorithms
ALGO-BREAST-HR-POS-2L- ALGO-BREAST-HR-POS-2L
Drug Indications
DIND-ALPELISIB-BREAST-HR-POS-2L-PIK3CA- DIND-ALPELISIB-BREAST-HR-POS-2L-PIK3CA
Handbook Chapters
HB-BREAST-HR-POS-HER2-NEG-1L- HR+/HER2- metastatic breast cancer: first-line reasoning
Handbook Questions
HQ-BREAST-HR-POS-1L-002- HQ-BREAST-HR-POS-1L-002