July 2019 Ask the Expert: Alpelisib and Other Treatments for Metastatic Hormone Receptor-Positive Breast Cancer
The listeners to New Approval for Metastatic Breast Cancer: Alpelisib, Living Beyond Breast Cancer’s July 22, 2019, webinar, had more questions than we had time to answer. Medical oncologist Adam Brufsky, MD, PhD, agreed to answer the remaining questions in writing. To learn more about alpelisib (Piqray), CDK 4/6 inhibitors, and other treatments used today for metastatic hormone receptor-positive breast cancer, listen to Dr. Brufsky’s full recording.
Remember: we cannot provide diagnoses, medical consultations or specific treatment recommendations. This service is designed for educational and informational purposes only. The information is general in nature. For specific healthcare questions or concerns, consult your healthcare providerbecause treatment varies with individual circumstances. The content is not intended in any way to substitute for professional counseling or medical advice.
Not that we know of.
Not that I know of. It would not stop me from prescribing alpelisib (Piqray).
There are no data on this, so we do not know.
We are not sure, and I would be careful with probiotics in this situation.
There are currently trials testing anti-HER2 agents with alpelisib, but they are not complete, so we do not know if they will work well together. I am not sure of the names, but you can search NCI PDQ for these. [Editor’s note: Here are trials on clinicaltrials.gov, some based in the U.S. and some abroad.]
I am happy it is working, and in this case insulin is not inhibiting alpelisib.
Most people end up on metformin to control the high sugars with alpelisib.
This really depends on your insurance plan and coverage, but the price to insurance (not to the patient) is about $10,000-$15,000 per month. [Editor’s note: The list price for a 28-day supply is $15,500. Novartis, the maker of alpelisib, has patient assistance programs and a Patient Support Line. Visit the website for more information.]
There is no evidence for waiting, but there are trials of staying on the same CDK 4/6 and trying another hormonal therapy as a strategy. [Editor’s note: We found four U.S. trials on clinicaltrials.gov that look at how CDK inhibitors may be used after the cancer progresses with a hormonal therapy and CDK inhibitor.]
Our group and others have presented data on this strategy and will publish it soon. This could be a possible idea to pursue.
The CDK 4/6 generally still works.
Less side effects and yes, to increase the number of possible treatments.
It can come from CDK 4/6 resistance.