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When would you consider fulvestrant +capivasertib over CDK4/6 inhibitors in a patient who has HR+, PIK3CA mutant, metastatic breast cancer?
Answer from: Medical Oncologist at Community Practice
Only in second-line with appropriate mutations as per NCCN guidelines.
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Answer from: Medical Oncologist at Academic Institution
A PIK3CA mutation is prognostic but not predictive for response to a CDK4/6i. The only situation I would consider skipping over CDK4/6i therapy and doing fulvestrant+capi in the 1st line metastatic setting is if the patient had recurrence on adjuvant abema/ribo +AI and NGS showed a PIK3CA mutation. ...
Answer from: Medical Oncologist at Community Practice
If a patient had a PIK3CA mutation and was progressing on front-line endocrine therapy + a CDK4/6 inhibitor, I would treat with fulvestrant and capivasertib rather than fulvestrant and another CDK4/6 inhibitor in the second-line setting.