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The authors of this subgroup analysis from the SOLAR-1 trial evaluated the impact of the combination of alpelisib and fulvestrant on healthcare-related quality of life in patients with PIK3CA-mutated, HR-positive, HER2-negative advanced breast cancer. Based on a European cancer quality-of-life inventory, healthcare-related quality of life was maintained with the addition of alpelisib to fulvestrant. Symptom subscale scores for appetite loss, diarrhea, nausea, vomiting, and fatigue were worse compared with baseline in the alpelisib group, and this was consistent with the known side-effect profile of alpelisib.
These results confirm the general tolerability of alpelisib plus fulvestrant in patients with PIK3CA-mutated, HR-positive, HER2-negative advanced breast cancer.
In the phase III SOLAR-1 trial (NCT02437318), the PI3Kα-selective inhibitor and degrader alpelisib significantly improved median progression-free survival when added to fulvestrant in patients with phosphatidylinositol-4,5-bisphosphate 3-kinase catalytic subunit alpha (PIK3CA)-mutated, hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer. We assessed health-related quality of life using patient-reported outcome measures in these patients.
MATERIALS AND METHODS
In the PIK3CA-mutant cohort, 341 patients were randomly assigned 1:1 to receive alpelisib 300 mg daily or placebo plus fulvestrant 500 mg on days 1 and 15 of cycle 1 and on day 1 of subsequent 28-day cycles. Patient-reported outcomes were evaluated with the European Organisation for Research and Treatment of Cancer QoL of Cancer Patients and Brief Pain Inventory-Short Form questionnaires. Changes from baseline and time to 10% deterioration were analyzed using repeated measurement models and Cox models, respectively.
Global Health Status/QoL and functional status were maintained from baseline (mean changes < 10 points) in the alpelisib (overall change from baseline [95% CI], -3.50 [-8.02 to 1.02]) and placebo arms (overall change from baseline [95% CI], 0.27 [-4.48 to 5.02]). Overall treatment effect in Global Health Status/QoL was not significantly different between arms (-3.77; 95% CI, -8.35 to 0.80; P = .101). Time to 10% deterioration for Global Health Status/QoL was similar between arms (hazard ratio, 1.03; 95% CI, 0.72 to 1.48). Compared with placebo, deterioration in social functioning and in diarrhea, appetite loss, nausea or vomiting, and fatigue symptom subscales occurred with alpelisib. Numerical improvement in Worst Pain was observed with alpelisib versus placebo (42% v 32%, week 24; P = .090).
In SOLAR-1, there was no statistical difference in deterioration of Global Health Status/QoL between arms, whereas symptom subscales favored placebo for diarrhea, appetite loss, nausea or vomiting, and fatigue, known side effects of alpelisib. Treatment decisions must consider efficacy and tolerability; taken with clinical efficacy, these results support the benefit-risk profile of alpelisib in patients with hormone receptor-positive, human epidermal growth factor receptor 2-negative PIK3CA-mutated advanced breast cancer.
Patient-Reported Outcomes in Patients With PIK3CA-Mutated Hormone Receptor–Positive, Human Epidermal Growth Factor Receptor 2–Negative Advanced Breast Cancer From SOLAR-1
J. Clin. Oncol 2021 Mar 29;[EPub Ahead of Print], EM Ciruelos, HS Rugo, IA Mayer, C Levy, F Forget, JI Delgado Mingorance, T Safra, N Masuda, YH Park, D Juric, P Conte, M Campone, S Loibl, H Iwata, X Zhou, J Park, A Ridolfi, I Lorenzo, F André