How do you decide between a PARP inhibitor or alpelisib for patients with metastatic ER+, gBRCA+, PI3K mutated breast CA with progression on CDK 4/6 inhibitor/fulvestrant?

There is preclinical data that blockade of pik3ca/mtor pathway can sensitize cancer cells to PARP inhibitors by inhibiting homologous repair (Ibrahim et al Cancer Discovery 2012). We published case series data for our patients treated on the BROCADE trial showing a tripling of PFS for BRCA2+ ER posi...

The Solar-1 study utilized fulvestrant with or without alpelisib for patients who have previously progressed on aromatase inhibitor. All the patients were fulvestrant naïve. For a patient with germline BRCA and her2 neg breast cancer, I would enroll on clinical trial utilizing olaparib with or witho...

For a patient with metastatic breast cancer, it’s important to know which medications the patient received, how long the patient’s cancer responded to those therapies, and the complete molecular profile in order to plan future therapies. In this scenario, I would use a PARP inhibitor because the PAR...

I would likely offer PARP inhibitor first considering the toxicity profile and available evidence suggesting it is more effective if used earlier. Having said that, there is early safety data on combining olaparib and alpelisib in TNBC (Batalini et al., PMID 35149538), and would be interesting to un...