Metastatic Breast Cancer Video Perspectives
VIDEO: PI3K inhibitors, combinations maintain quality-of-life in metastatic breast cancer
Transcript
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The current PI3K 3C inhibitors in use in advanced breast cancer are alpelisib and inavolisib. Capivasertib is an AKT inhibitor, which is also used in PI3K 3C mutated breast cancer. So these are oral therapies and are associated with side effects such as hyperglycemia, diarrhea, rash, and fatigue.
So as medical providers, we worry about adversely impacting our patient's quality of life with such side effects. However, the randomized clinical trials that brought us these therapies have reported quality of life outcomes that support its use.
Patient reported outcomes from solar one, that was the study that tested at abemaciclib with fulvestrant showed global health status and quality of life were maintained in the treatment arm. All those symptom subsets favored placebo, especially due to diarrhea that contributed to reduced social functioning. But overall, the outcomes were actually similar.
In CAPItello-291 that tested capivasertib in fact demonstrated that time to deterioration of quality of life was increased 24 months in treatment arm versus 12 months in the placebo arm. And problematic symptoms like diarrhea occurred early and were subsequently managed.
The third study using the PI3K inhibitor that was most recently introduced inavolisib tested inavolisib with a CDK inhibitor, palbociclib and fulvestrant. And so this is a triplet regimen. We are concerned that adding therapies will increase toxicity. However, this study showed that it took a longer time to deterioration of symptoms such as pain along with maintenance of function compared with placebo.
So overall patients on PI3K 3C inhibitors require close monitoring, appropriate dose reductions, and aggressive supportive measures like the use of antidiarrheals and dietary modifications in order to be able to stay on therapy as these trials have demonstrated, and also to maintain a good quality of life.
