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.

Source YAML: complete record

Components	`DRUG-ALPELISIB` `DRUG-FULVESTRANT`

ID	`REG-ALPELISIB-FULVESTRANT-BREAST`
Type	Regimen
Status	reviewed 2026-04-27 \| pending_clinical_signoff
Diseases	None declared
Sources	`SRC-ESMO-BREAST-METASTATIC-2024` `SRC-NCCN-BREAST-2025` `SRC-SOLAR1-ANDRE-2019`

Notes

SOLAR-1: PIK3CA-mutant cohort PFS 11.0 vs 5.7 mo (HR 0.65). PIK3CA testing (tissue NGS or ctDNA) required pre-start. Hyperglycemia management dominant clinical workflow burden — joint endocrinology follow-up recommended.

Used By

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

Indication

IND-BREAST-HR-POS-2L-PIK3CA-ALPELISIB - IND-BREAST-HR-POS-2L-PIK3CA-ALPELISIB